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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 Western Pennsylvania. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay when purchased at a preferred pharmacy or through mail order, but have a $12 copay at a standard pharmacy. Standard generic, preferred brand, and non-preferred drugs all have 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and 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 a copay, while outpatient services and many preventive services have no copay. The plan also covers emergency and ambulance services, along with primary care, hearing, vision, and dental services with copays or coinsurance. Additional benefits include home health services with no copay, and coverage for durable medical equipment and dialysis services with coinsurance. The plan provides coverage for some prescription hearing aids and eyewear, with limits on the annual combined benefit. Other services like over-the-counter items and meal benefits are included with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Value (PPO) plan, with a copay of $175 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric benefits are also covered, with a copay of $350 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0-$175, Observation Services have a copay of $175, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $30, Ambulatory Surgical Center Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (PPO) plan, with no copay required. 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 ambulance services have a $225 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay for 6 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Aetna Medicare Value (PPO), with a $125 copay, but this copay is waived if you are admitted to the hospital within 24 hours. Urgently Needed Services have a $45 copay, and Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $225 copay for Worldwide Emergency Transportation, up to a maximum of $150,000.
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 have a $10 copay, while Occupational Therapy Services have a $20 copay. Physician Specialist Services have a copay between $0 and $30. Mental Health Specialty Services, including Individual and Group Sessions, have a $30 copay. Podiatry Services and Routine Foot Care have a $20 copay for up to 4 visits per year. Other Health Care Professional services have a copay between $0 and $30. Psychiatric Services, including Individual and Group Sessions, have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services with a copay. Kidney Disease Education Services have a 20% coinsurance. Other services, such as Health Education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Wigs for Hair Loss Related to Chemotherapy have no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered for up to $500 per ear every year with no coinsurance, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay between $0 and $30, while eyewear has a $0 copay, and a combined maximum benefit of $225 every year for both in-network and out-of-network services.
Dental Services See details
Dental services include a $30 copay for Medicare dental services, while 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $2,500 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Value (PPO). This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
The Aetna Medicare Value (PPO) plan covers Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies and Diabetic Equipment with a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered by the Aetna Medicare Value (PPO) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $225, Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered under 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 covered by the Aetna Medicare Value (PPO) plan, but the plan does not cover any of the sub-services. There is a copay for these services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value (PPO) with a copay of $10 for days 1-20 and $214 for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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