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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Value Care (PPO) is a PPO plan offered by Aetna Life Insurance Company available for the 2026 plan year to people living in Select Counties in Atlanta Metro. 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 $25.40. 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. If standard pharmacies or standard mail-order services are used, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply fill. Higher-tier prescription drugs are subject to coinsurance rather than set copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance at all pharmacies and mail-order options. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers comprehensive medical coverage with predictable costs, including no copay and no coinsurance for primary care visits, home health services, and annual physicals. Specialist visits require a low copay of $10 to $45, while inpatient hospital stays feature daily copays for the first few days and no copay for subsequent days. Outpatient services and emergency care are also covered with no coinsurance, though they carry varying copays depending on the specific service. This plan also includes valuable supplemental benefits, featuring no copay and no coinsurance for routine hearing exams, eyewear, and preventive dental care. Comprehensive dental services are covered with no copay and a 20% to 50% coinsurance up to a $2,500 annual limit, while prescription hearing aids are covered up to $500 per ear annually. Additionally, members benefit from a $200 annual allowance for eyewear and a $30 quarterly reimbursement for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Value Care (PPO) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $388 daily copay for days 1 to 7 and no copay for day 8 and beyond, while psychiatric stays require a $678 daily copay for days 1 to 3 and no copay for days 4 to 90.
Outpatient Services See details
Aetna Medicare Value Care (PPO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $388 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copays or coinsurance, while outpatient substance abuse services require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Care (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (PPO) covers ground ambulance services with a $285 copay and air ambulance services with a 20% coinsurance, both of which require prior authorization. Transportation services 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 $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency and urgent care are covered with a $115 copay, and worldwide emergency transportation carries a $285 copay, with no coinsurance up to a $250,000 maximum plan benefit limit.
Primary Care See details
Aetna Medicare Value Care (PPO) partially covers primary care benefits, as chiropractic and podiatry services are not covered. Covered services include primary care physician visits with no copay and no coinsurance, specialist visits for a $10 to $45 copay and no coinsurance, and physical, occupational, and mental health therapies with copays ranging from $35 to $40 and no coinsurance.
Preventive Services See details
Aetna Medicare Value Care (PPO) offers partially covered preventive services, with no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes self-management, and select supplemental benefits. While kidney disease education requires a 20% coinsurance with no copay, several services such as weight management, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Value Care (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, though inner ear, outer ear, over-the-ear, and over-the-counter 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 $45 copay for eye exams and no copay for eyewear. The plan offers up to a $50 annual maximum for eye exams and a $200 yearly combined maximum allowance for contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Aetna Medicare Value Care (PPO) provides partially covered dental services, featuring Medicare-covered dental care with a $45 copay and no coinsurance, alongside preventive care with no copay and no coinsurance. Comprehensive services require no copay with 20% to 50% coinsurance up to a $2,500 annual limit, but other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Care (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Value Care (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers medical equipment with prior authorization, offering durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies from specified manufacturers are covered with no copay and up to 20% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Value Care (PPO) with prior authorization required, featuring no copay for lab services and outpatient X-rays. Diagnostic tests have no coinsurance and a copay ranging from $0 to $120, while diagnostic radiological services have no minimum copay 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, although 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, and while some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered and require copays ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Care (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Care (PPO) provides partially covered other services with no copay and no coinsurance, although acupuncture is not covered. Covered benefits include a $30 quarterly reimbursement for over-the-counter items, a meal benefit for chronic illness, and select wellness exams and cancer screenings.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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* 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.
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