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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 Eastern North Carolina. 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 $250.00 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 $7750.00 (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 $7750.00 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 a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For the initial coverage phase, you can expect to pay a $10-$12 copay for preferred generics, and 25%-30% coinsurance for other drugs. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays that vary by day, while outpatient services have copays between $0 and $374. The plan also covers ambulance services, emergency services, and a variety of primary care and preventive services with no copay. This plan includes coverage for hearing, vision, and dental services, often with no copay. It also covers services such as home health, medical equipment, and skilled nursing facilities with copays or coinsurance requirements. However, the plan has some exclusions, such as certain hearing aids, and specific dental, and other services, so it is important to review the details carefully.
Inpatient Hospital See details
The Aetna Medicare Value (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with prior authorization required. For inpatient hospital-acute, you'll pay a \$374 copay for days 1-8 and no copay for days 9-90, while inpatient hospital-psychiatric has a \$286 copay for days 1-8 and no copay for days 9-90. Additional days for inpatient hospital-acute are covered with no copay, but non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and additional days and non-Medicare-covered stays for inpatient hospital-psychiatric are also not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay of $0 - $374, observation services with a copay of $374, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $40 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. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Value (PPO) plan with a $100 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are also covered, with copays of $100 and $275, respectively.
Primary Care See details
Primary Care services are covered under the Aetna Medicare Value (PPO) plan, including Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a copay between $0 and $35, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Mental Health and Psychiatric services have a $40 copay for individual and group sessions. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include no copay for annual physical exams and additional preventive services, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies. Kidney Disease Education Services have a 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered up to $1250 per year, and prescription hearing aids (all types) have no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value (PPO) plan covers vision services, including eye exams with a copay of $0-$30 and routine eye exams and other eye exam services with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are also covered with no copay, but have a combined maximum plan benefit coverage of $150 per year.
Dental Services See details
The Aetna Medicare Value (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. This plan also offers a yearly maximum benefit of $1,000 for both in-network and out-of-network services and covers restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. However, this plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Value (PPO) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20% and no copay. 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, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at least 20%.
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 by the Aetna Medicare Value (PPO) plan. However, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (PPO) plan with prior authorization. You will pay a copay of $10 for days 1-20, and a copay of $214 for days 21-100.
Other Services See details
Other Services include coverage for over-the-counter items and meal benefits with no copay. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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