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Aetna Medicare Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Value (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IN Central. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Value (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Value (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after the deductible is met, you will pay either a copay or coinsurance depending on the drug tier. For preferred generic drugs, there is no copay at preferred pharmacies and mail order pharmacies, and a $12.00 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, but many outpatient services, including primary care and preventive services, have no copay. The plan also covers hearing, vision, and dental services with specific copays and maximum benefits. Additional benefits include ambulance services with copays, emergency services with copays, and coverage for home health services with no copay, but some services require prior authorization. The plan also offers coverage for prescription hearing aids, eyewear, and dental services, along with over-the-counter items and some prescription drugs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Value (PPO) plan. For Inpatient Hospital-Acute, you will pay a $310 copay for days 1-7, and no copay for days 8-90. Inpatient Hospital Psychiatric services have the same cost sharing as Inpatient Hospital-Acute. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Value (PPO) plan, including outpatient hospital services with a copay between $0 and $310, observation services with a $310 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $75 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value (PPO) plan, but requires prior authorization. You will have a $75 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground Ambulance Services have a $295 copay, while Air Ambulance Services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Value (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency and Urgent Coverage, and a $295 copay for Worldwide Emergency Transportation, with a maximum benefit of $100,000.
Primary Care See details
The Aetna Medicare Value (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $30 copay, physician specialist services with a $30 copay, and physical therapy and speech-language pathology services with a $30 copay. Mental health and psychiatric services, individual sessions for mental health and psychiatric services with a $40 copay, and group sessions for mental health and psychiatric services with a $40 copay require prior authorization, while podiatry services are not covered. Other health care professional services have a copay between $0 and $30, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75. Opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services like health education, wigs for hair loss, nutritional/dietary benefits, additional smoking cessation counseling, memory fitness, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The Aetna Medicare Value (PPO) plan covers hearing exams for a $30 copay and routine hearing exams and fitting/evaluation for hearing aids with no copay, each limited to one visit per year. Prescription hearing aids are covered up to $500 per ear annually, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$30, and routine eye exams, and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit coverage of $165 per year.
Dental Services See details
The Aetna Medicare Value (PPO) plan covers dental services with a $30 copay for Medicare dental services, and a maximum benefit of $1800 per year for in-network and out-of-network services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery all have no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Value (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (PPO) plan. You will pay a coinsurance of 20% for this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Aetna Medicare Value (PPO) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, and durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, while medical supplies have a coinsurance between 0% and 20%. Diabetic supplies have a coinsurance between 0% and 20%, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $100, and lab services with no copay. Therapeutic Radiological Services have a coinsurance of at least 20%, while Diagnostic Radiological Services have a copay of at most $275, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
The Aetna Medicare Value (PPO) plan covers Skilled Nursing Facility (SNF) services, but prior authorization is required. For days 1-20, there is no copay, while days 21-100 have a $214 copay.
Other Services See details
Aetna Medicare Value (PPO) covers Over-the-Counter (OTC) Items with no copay, a maximum plan benefit of $60 every three months, and offers nicotine replacement therapy and Naloxone coverage. Other services like acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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