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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 Bowling Green/Southwest KY Area. 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 $9550.00 (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 $9550.00 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 $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For example, you will pay no copay for preferred generic drugs at preferred and mail-order pharmacies. For standard generic drugs, you will pay 24% coinsurance, and for preferred brand and non-preferred drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers a wide range of benefits. Inpatient hospital stays have a $300 copay for days 1-6, and then no copay for the remainder of the stay. Outpatient services, primary care, preventive services, and home health services often have no copay. The plan also covers hearing, vision, and dental services, with varying copays or coinsurance. Emergency services, ambulance services, and skilled nursing facilities are covered with specific copays, and some services such as home infusion bundled services and dialysis have coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $300 copay for days 1-6, and no copay for days 7-90. 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
The Aetna Medicare Value (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $275, observation services with a $300 copay, 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 are also covered with no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Aetna Medicare Value (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground and air ambulance services have a $250 copay, and there is no coinsurance. 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 and Worldwide Emergency Coverage have a $125 copay, Worldwide Urgent Coverage also has a $125 copay, Worldwide Emergency Transportation has a $250 copay, and Urgently Needed Services have a $45 copay.
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 services with a $40 copay, physician specialist services with a $0-$35 copay, and physical therapy and speech-language pathology services with a $40 copay. The plan also covers mental health and psychiatric services, podiatry services, other health care professional services, additional telehealth benefits, and opioid treatment program services with varying copays.
Preventive Services See details
The Aetna Medicare Value (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a plan-specified amount up to $1250 per year. Prescription hearing aids (all types) have no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$45, and eyewear has no copay, with a combined maximum benefit of $200 per year for both in-network and out-of-network services.
Dental Services See details
Dental services are covered under the Aetna Medicare Value (PPO) plan, with a $1,000 maximum per year for both in-network and out-of-network services. There is no copay for Medicare dental 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (PPO) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with coinsurance for Medicare-covered items, and Diabetic Equipment, which may have a coinsurance of 0% to 20% and copays for certain services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with copays and coinsurance varying by service. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $100, 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services (Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, Additional Cardiac Rehabilitation Services) are covered. There is a copay for the covered services, but the amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the Aetna Medicare Value (PPO) plan, Other Services include no copay for Over-the-Counter (OTC) items, with a maximum benefit of $100 every three months, and no copay for annual wellness exams and screening mammography and gFOBT and FIT. Acupuncture, meal benefits, 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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