A non-government entity
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 MI Middle. 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 $7500.00 (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 $7500.00 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:
Sign up for Aetna Medicare Value (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Value (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the following costs for drugs. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. Once your total drug costs reach $2000, 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. Inpatient hospital stays require a $280 copay for days 1-6, with no copay thereafter. Outpatient services have copays ranging from $0 to $280, and emergency services have a $125 copay. The plan includes no copay for primary care visits and many preventive services, as well as hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and eyewear. Dental services have a $35 copay for Medicare dental services, and prescription hearing aids are covered with a maximum plan benefit coverage of $500 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $280 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $280 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the Aetna Medicare Value (PPO) plan covers all outpatient hospital services, with a copay between $0 and $280 for outpatient hospital services and a $280 copay for observation services. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value (PPO) plan, with a $75 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground Ambulance Services have a $325 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Value (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have copays of $125, $125, and $325, respectively.
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 $30 copay, and physician specialist services with a $35 copay. Mental health specialty services, including individual and group sessions, have a $40 copay. Other health care professionals may have a copay between $0 and $35, and physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $75. Opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services with no copay for Medicare-covered glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Kidney Disease Education Services have a 20% coinsurance. Additional services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit coverage of $500 per year, and prescription hearing aids (all types) have no copay. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams may have a copay between $0 and $35, and eyewear has a combined maximum plan benefit of $180 per year with no copay.
Dental Services See details
The Aetna Medicare Value (PPO) plan covers dental services with a $35 copay for Medicare dental services, and a $1,200 annual maximum for both 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization 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) with a coinsurance of 20%. Prior authorization is required for coverage.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance of 0-20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a coinsurance of 20% and 0-20%, respectively. Diabetic Supplies have a coinsurance of 0-20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $350, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $20 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 technically covered, but not in practice. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value (PPO), but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional and non-Medicare-covered SNF days are not covered.
Other Services See details
The Aetna Medicare Value (PPO) plan covers Over-the-Counter (OTC) Items with no copay, a maximum benefit of $75 every three months, and it offers nicotine replacement therapy and Naloxone. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved