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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 MI Southeast. 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 $46.00. 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 prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail-order service for up to a three-month supply. If standard pharmacies or standard mail-order options are used, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. Higher-tier medications transition to coinsurance, with Tier 3 preferred brand drugs requiring a 22% coinsurance across all pharmacy and mail-order options. Both Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 25% coinsurance, with specialty drugs limited to a one-month supply. This cost-sharing structure helps beneficiaries estimate their out-of-pocket prescription costs when choosing this PPO plan.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, home health services, and annual physicals. Specialist visits require a low copay of $10 to $20, while inpatient hospital stays carry a $300 daily copay for days 1 through 7 and no copay for days 8 through 90. Emergency care is covered with a $130 copay that is waived upon hospital admission, and urgent care visits require a $35 copay. Supplemental benefits include routine vision and hearing exams with no copay, alongside a $250 annual eyewear allowance and up to $1,000 per ear for prescription hearing aids at no cost. Comprehensive dental services are covered with no copay and a 20% to 50% coinsurance up to a $2,500 annual limit. Members also benefit from an over-the-counter allowance of up to $75 every three months with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered under the Aetna Medicare Value Care (PPO) with no coinsurance, requiring a $300 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Aetna Medicare Value Care (PPO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services carry a copay of $0 to $300, observation services require a $300 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 no coinsurance and a copay of either $75.00 or $145.00. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services under the Aetna Medicare Value Care (PPO) require prior authorization and cost a $255 copay with no coinsurance for ground transport, or a 20% coinsurance with no copay for air transport, with neither fee waived if admitted to the hospital. Transportation services to 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. Urgent care is covered with a $35 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $255.
Primary Care See details
Aetna Medicare Value Care (PPO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $10 to $20 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric services are covered with copays ranging from $30 to $40 and no coinsurance, while telehealth services have a $0 to $40 copay and 20% coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Care (PPO), featuring no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes self-management, and select supplemental benefits, though kidney disease education requires a 20% coinsurance with no copay. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, 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) hearing services are partially covered, with Medicare-covered exams requiring a $20 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $1,000 annual maximum per ear, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services covered under the Aetna Medicare Value Care (PPO) include eye exams with no coinsurance and a $0 to $20 copay, which includes one routine exam per year. Covered eyewear, including contacts and eyeglasses, features no copay and no coinsurance up to a $250 annual combined maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Care (PPO), with preventive cleanings, exams, and x-rays requiring no copay and no coinsurance, while fluoride, other diagnostic, and other preventive services are not covered. Covered comprehensive services feature no copay and 20% to 50% coinsurance up to a $2,500 annual limit, but implants, maxillofacial prosthetics, and orthodontics are excluded. Medicare-covered dental services are available with a $20 copay and no coinsurance.
Home Infusion bundled Services See details
Aetna Medicare Value Care (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Value Care (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays for all covered items. Coinsurance ranges from no coinsurance to 20% depending on the equipment, though prosthetic devices require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Value Care (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures carry a copay of $0 to $65 with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under 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 by Aetna Medicare Value Care (PPO) with no coinsurance, but only some services are covered. Specifically, cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Care (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Care (PPO) partially covers other services, offering no copay and no coinsurance for covered benefits like an annual wellness exam, screening mammography, additional gFOBT and FIT, and over-the-counter (OTC) items up to $75 every three months via reimbursement. However, acupuncture, meal benefits, and certain other services are not covered under this plan.
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