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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 Select LA Parishes. 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 $6.00. 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:
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Drug Coverage
The Aetna Medicare Value Care (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs require a copay starting at $2, while Tier 2 drugs start at a $12 copay for a 1-month supply. For brand-name and specialty medications, costs transition to a percentage-based coinsurance instead of a flat copay. Tier 3 preferred brands require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance across all pharmacy and mail-order options. Additionally, Tier 5 specialty medications are limited to a 1-month supply.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers strong coverage for core medical needs, featuring no copays or coinsurance for primary care visits, preventive services, and routine home health care. Specialist visits, urgent care, and emergency services are covered with predictable copayments and no coinsurance, though inpatient hospital stays require daily copays for the first few days of your stay. Outpatient services and diagnostic tests are also highly accessible, ranging from no copay to modest copayments with no coinsurance. For specialized care, the plan provides routine dental, vision, and hearing benefits with no copays, alongside allowances for eyewear and prescription hearing aids. While comprehensive dental, dialysis, and durable medical equipment require a standard 20% to 50% coinsurance, other services like skilled nursing facility stays offer no copay for the first 20 days. Overall, this PPO plan minimizes out-of-pocket costs by replacing coinsurance with predictable copays for most primary, outpatient, and rehabilitation services.
Inpatient Hospital See details
Inpatient hospital benefits under the Aetna Medicare Value Care (PPO) are partially covered with no coinsurance, requiring a $250 daily copay for days 1 to 10 of acute stays and a $678 daily copay for days 1 to 3 of psychiatric stays, with no copays for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Care (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $375, alongside observation services for a $275 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copays and no coinsurance, while outpatient substance abuse sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Care (PPO) with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (PPO) covers ground ambulance services with a $295.00 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are not covered in practice, as trips to plan-approved or any 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, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $130 to $295.
Primary Care See details
Primary Care benefits under the Aetna Medicare Value Care (PPO) plan feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $10 to $35 copay and no coinsurance. Other covered services like physical, occupational, and mental health therapies require copays ranging from $35 to $50 and no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Care (PPO), with no copay and no coinsurance for annual physicals, health education, and select screenings, while kidney disease education has no copay and a 20% coinsurance. Specific sub-services like in-home safety assessments, personal emergency response systems, weight management programs, and nutritional benefits are not covered.
Hearing Services See details
Aetna Medicare Value Care (PPO) provides partially covered hearing services, including Medicare-covered exams for a $35 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with a $500 maximum per ear and no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Care (PPO) covers vision services with no deductibles and no coinsurance, featuring a $0 to $35 copay for eye exams and no copay for eyewear. Routine eye exams and eyewear, including contacts and eyeglasses, feature no copay, with eyewear covered up to a combined annual maximum of $200 for both in-network and out-of-network services.
Dental Services See details
Aetna Medicare Value Care (PPO) covers preventive dental services like exams, cleanings, and x-rays with no copay and no coinsurance, while Medicare-covered dental services require a $35 copay and no coinsurance. Comprehensive dental services are partially covered up to a $2,000 annual limit with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Care (PPO) with no copay, requiring prior authorization and step therapy. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Value Care (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic supplies are covered with no coinsurance to 20% coinsurance from specified manufacturers, while diabetic therapeutic shoes and inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Value Care (PPO) plan, with prior authorization required. Diagnostic tests and procedures have no coinsurance and a copay ranging from $0 to $95, while lab services, outpatient X-rays, and diagnostic radiological services feature no copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Value Care (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Value Care (PPO) plan with no coinsurance, though copays apply for individual services. You will pay a $25 copay for both cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $20 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
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 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Care (PPO) partially covers Other Services with no copay and no coinsurance for covered benefits, including over-the-counter items, chronic illness meals, annual wellness exams, and extra colorectal screenings. Acupuncture is not covered under this plan.
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