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Aetna Medicare Value Care (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Care (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 Care (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Value Care (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 2026.
It's important to know that Aetna Medicare Value Care (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 Care (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 Care (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $33.00. 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 $615.00 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:
Sign up for Aetna Medicare Value Care (PPO)
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Drug Coverage
The Aetna Medicare Value Care (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when filled through a preferred retail pharmacy or preferred mail order service. If you utilize a standard pharmacy or standard mail order, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply length. Brand-name and specialty drugs under this plan are subject to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates remain consistent whether you use preferred or standard pharmacies, or choose to receive your medications via mail order.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care visits, preventive screenings, and home health care. Specialist visits require a copay ranging from $10 to $40, while inpatient hospital stays feature a daily copay of $315 for the first seven days of acute care. Emergency care is accessible with a $130 copay, and urgent care visits carry a $35 copay, both with no coinsurance. Routine hearing and vision exams are available with no copay or coinsurance, alongside annual allowances for hearing aids and eyewear. Preventive dental cleanings and exams also have no copay, while comprehensive dental services are covered up to a $1,500 annual limit with 20% to 50% coinsurance. Additionally, members pay no copay for durable medical equipment and receive a $15 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Value Care (PPO) with no coinsurance, requiring a $315 copay for days 1 to 7 of acute stays and a $285 copay for days 1 to 7 of psychiatric stays, with no copay for subsequent covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric stay days are not covered.
Outpatient Services See details
Outpatient services are covered under the Aetna Medicare Value Care (PPO) with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Medicare-covered outpatient hospital services require a copay of $0 to $315, observation services carry a $315 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Care (PPO) with a copay of either $75.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services under Aetna Medicare Value Care (PPO) cover ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Some transportation services are covered, but trips to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Value Care (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $35 copay and no coinsurance, while worldwide emergency care is covered up to $250,000 with no coinsurance and copays ranging from $130 to $295.
Primary Care See details
Aetna Medicare Value Care (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $10 to $40 copay with no coinsurance. Physical, occupational, speech, and mental health therapies have copays ranging from $40 to $45 with no coinsurance, though telehealth services require a 20% coinsurance, and routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Care (PPO), offering no copay and no coinsurance for annual physicals, health education, and screenings, while kidney disease education has no copay and a 20% coinsurance. Supplemental services not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Value Care (PPO) provides partially covered hearing services, featuring Medicare-covered exams for a $40 copay and routine exams or fittings with no copay and no coinsurance. Up to two prescription hearing aids are covered annually up to $500 per ear with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Care (PPO) with no deductible and no coinsurance. Eye exams have a copay of $0 to $40 with a $50 annual maximum, while eyewear is covered with no copay up to a combined annual limit of $175.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Care (PPO), featuring no copay and no coinsurance for preventive cleanings and exams, and a $40 copay with no coinsurance for Medicare-covered dental. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $1,500 annual limit, but other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Care (PPO) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance. Medicare Part B insulin is also covered under this benefit with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Value Care (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Care (PPO) with no copays for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Coinsurance ranges from no coinsurance up to 20% depending on the item, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Value Care (PPO) with prior authorization required. Lab services have no copay or coinsurance, diagnostic tests carry a $0 to $50 copay with no coinsurance, outpatient X-rays have a $20 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Value Care (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Aetna Medicare Value Care (PPO) with no coinsurance, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Care (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 copay per day for days 21 through 100. Prior authorization is required and less than a three-day prior hospital stay is allowed, but additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Value Care (PPO) with no copay and no coinsurance for covered benefits, including an annual wellness exam, screening mammography, additional gFOBT and FIT, and up to $15 every three months for over-the-counter items. Acupuncture, meal benefits, and Dual Eligible SNPs are not covered.
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