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Aetna Medicare Value Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (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 Plus (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Value Plus (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 2025.
It's important to know that Aetna Medicare Value Plus (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 Plus (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 Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 $8950.00 (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 $8950.00 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 Plus (PPO) plan has a $590 deductible for prescription drugs. After you pay the deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy used. For Tier 1 preferred generic drugs, there is no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For other tiers, you will pay 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive coverage with varying cost-sharing. You'll find no copay for primary care, preventive services like annual exams, and many dental and vision services. However, you'll encounter copays for inpatient hospital stays, outpatient services, specialist visits, and emergency services, as well as coinsurance for services like air ambulance and dialysis.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and psychiatric care. For acute care, you will pay a $285 copay for days 1-8, and no copay for days 9-90; for psychiatric care, you will pay a $285 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $365, observation services with a $365 copay, Ambulatory Surgical Center (ASC) services with no copay, and outpatient substance abuse services with a $75 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. You will have a $75 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (PPO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% 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 by the Aetna Medicare Value Plus (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $295 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, and Individual Sessions for Psychiatric Services all have a $40 copay, and Physician Specialist Services have a $20 copay. Other Health Care Professional services have a copay that ranges from $0 to $20, and Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additionally, Additional Telehealth Benefits have a 20% coinsurance and a copay that ranges from $0 to $75.
Preventive Services See details
The Aetna Medicare Value Plus (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, with services such as Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies having no copay. The plan covers Wigs for Hair Loss Related to Chemotherapy with no copay and a maximum plan benefit coverage amount of $400.00. The plan also covers Kidney Disease Education Services with 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 $20 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $1,000 per ear every year, and all types of prescription hearing aids have no copay for two visits per year. OTC hearing aids are not covered, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Value Plus (PPO) plan covers vision services, including eye exams with a copay of $0-$20, and eyewear with a combined maximum plan benefit of $245 per year and no copay. Routine eye exams have no copay and are limited to one per year, while other eye exam services and eyewear like contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited with no copay.
Dental Services See details
Dental services are covered, with a $20 copay for Medicare dental services, which require prior authorization. Other services include 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, all of which have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum plan benefit coverage of $2200 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required, including Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Medicare Part B Insulin Drugs have a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Value Plus (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20% and requires authorization. Prosthetics/Medical Supplies have a coinsurance, and Diabetic Equipment benefits are covered with a coinsurance between 0% and 20% and a copay for some services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay between $0 and $50, and lab services with no copay. Diagnostic Radiological Services have a copay up to $275, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (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 not covered by the Aetna Medicare Value Plus (PPO) plan. While some services are covered, 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) benefits are covered by the Aetna Medicare Value Plus (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan does not cover acupuncture. Over-the-counter (OTC) items are covered with no copay, and a maximum benefit of $45 every three months. The plan also covers meal benefits with no copay. The plan also covers annual wellness exams and screening mammography, and gFOBT and FIT, all with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services are not covered.
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