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 Upper Peninsula. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8500.00 (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 $8500.00 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 $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. After 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. For inpatient hospital stays, you'll pay a copay of $300 for the first 7 days, with no copay for additional days. Outpatient services have varying copays, and emergency services have a $125 copay. This plan also covers primary care with no copays for many services, and preventive services such as annual physical exams with no copay. Hearing services offer hearing exams with a $35 copay and hearing aids with no copay. Vision and dental services are covered, with a combined maximum of $190 per year for vision and a $1,250 annual maximum for dental.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization required. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, the copay is $270 for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0-$325, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $75 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value (PPO) plan, but requires prior authorization. You will have a $75 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan, with a $275 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, including Emergency Services, Urgently Needed Services, and Worldwide Emergency Services. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $275 copay; all services have no coinsurance.
Primary Care See details
Under the Aetna Medicare Value (PPO) plan, Primary Care includes several services. Primary Care Physician and Physician Specialist Services have no copay, while Chiropractic Services have a $20 copay for routine care. Occupational Therapy Services, Mental Health Specialty Services (individual and group sessions), Psychiatric Services (individual and group sessions), and Opioid Treatment Program Services have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Other Health Care Professional services have a copay between $0 and $35. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $75. Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Value (PPO) plan covers preventive services, including an annual physical exam with no copay, and provides coverage for kidney disease education services with a 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.
Hearing Services See details
Hearing Services include 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 benefit of $500 per ear every year, and prescription hearing aids (all types) have no copay. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, with routine eye exams and other eye exam services having no copay, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay, and a combined maximum of $190 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Value (PPO) plan covers dental services with a $1,250 maximum benefit each year; Medicare Dental Services have a $35 copay. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment benefits are covered under the Aetna Medicare Value (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, and lab services, are covered with a copay, and outpatient X-ray services have a $20 copay. Therapeutic Radiological Services have a 20% coinsurance.
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 not covered by the Aetna Medicare Value (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (PPO) plan, with a prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value (PPO) plan's "Other Services" benefit covers over-the-counter (OTC) items and meal benefits with no copay. Acupuncture, Dual Eligible SNPs, 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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