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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 WI Southeast. 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 $29.00. 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 $9950.00 (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 $9950.00 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 an enhanced alternative drug benefit. The plan has a deductible of $590.00. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay no copay at preferred pharmacies and a $12.00 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance depending on the pharmacy.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive coverage, including inpatient and outpatient services, with varying copays. You'll find no copay for primary care visits, many preventive services, home health services, and many dental services. The plan also includes coverage for hearing and vision services, with copays for exams and coverage for hearing aids and eyewear. Emergency services, ambulance services, and mental health services are covered, with copays ranging from $35 to $275. This plan also includes additional benefits like coverage for prescription hearing aids, and up to $2,000 per year for dental services. However, it's important to note that certain services like cardiac rehabilitation and some home care services are not covered.
Inpatient Hospital See details
The Aetna Medicare Value Plus (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with a $300 copay for days 1-7 and no copay for days 8-90. Additional days for inpatient hospital-acute are covered with no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Value Plus (PPO) plan. Outpatient hospital services have a copay between $0 and $350, observation services have a $350 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a $75 copay, and outpatient blood services have 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 Aetna Medicare Value Plus (PPO). Ground ambulance services have a $275 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 under the Aetna Medicare Value Plus (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Aetna Medicare Value Plus (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, while physician specialist services have a $0-$20 copay. Mental health specialty services, psychiatric services, and opioid treatment program services also have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay. Other health care professionals have a $0-$20 copay. Additional telehealth benefits have a 20% coinsurance and a $0-$75 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services like Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $20 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per ear every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay of $0-$20, and eyewear has no copay. The plan offers a combined maximum of $250 per year for eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, as well as other services like oral exams, dental x-rays, and cleanings with no copay, up to a maximum of $2,000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Value Plus (PPO) plan, which includes Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, though Durable Medical Equipment for use outside the home is not covered, and Prosthetic Devices with a 20% coinsurance. Diabetic Equipment is covered, with coinsurance of 0% to 20% for Diabetic Supplies and no copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $65, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $275, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under 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. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items and meal benefits are covered with no copay, and other services, including annual wellness exams, screening mammography, gFOBT, and FIT, are covered with no copay.
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