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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 WI 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 $21.10. 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:
Sign up for Aetna Medicare Value Care (PPO)
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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 generic and Tier 2 generic medications, members 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 $12 for a one-month supply. Higher-tier medications are subject to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 25% coinsurance. These coinsurance rates apply across all preferred, standard, and mail-order pharmacy options.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, annual physicals, and home health services. Specialist visits, physical therapy, and urgently needed care are highly affordable with low copays ranging from $10 to $35 and no coinsurance. For more intensive care, inpatient hospital stays require a daily copay of $300 to $350 for the first seven days with no copay thereafter, while emergency room visits carry a $130 copay that is waived if you are admitted. This plan also features strong supplemental benefits, including no-copay routine vision, hearing, and preventive dental exams, alongside an annual eyewear allowance of up to $200 and up to $750 per ear for prescription hearing aids. Comprehensive dental services are covered with no copay and a 20% to 50% coinsurance up to a $2,000 annual limit. Additionally, diagnostic lab tests, home infusion services, and skilled nursing facility stays for the first 20 days are all available with no copay.
Inpatient Hospital See details
Aetna Medicare Value Care (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $350 daily copay for days 1-7 and no copay thereafter, while psychiatric stays require a $300 daily copay for days 1-7 and no copay for days 8-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Care (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay, while outpatient hospital services have a copay ranging from $0 to $350. Outpatient substance abuse individual and group sessions are covered with a $40 copay, and prior authorization is required for several of these services.
Partial Hospitalization See details
Aetna Medicare Value Care (PPO) covers partial hospitalization services with a copay of either $75.00 or $145.00 and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (PPO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by the Aetna Medicare Value Care (PPO) plan with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care is available for a $35 copay with no coinsurance, and worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Value Care (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $10 to $35 copay and no coinsurance. Physical, occupational, and speech therapy services require a $35 copay and no coinsurance, while podiatry is not covered, and for chiropractic services, some services are covered but routine and other chiropractic services are not.
Preventive Services See details
Aetna Medicare Value Care (PPO) partially covers preventive services, offering annual physicals, screenings, health education, and fitness benefits with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several supplemental services like in-home safety assessments, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Aetna Medicare Value Care (PPO) covers hearing services, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Care (PPO) with no deductibles and no coinsurance, offering eye exams with copays ranging from no copay to $35. Eyewear, including contacts and eyeglasses, is covered with no copay up to a $200 annual maximum, while routine eye exams are covered up to a $50 annual limit.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Value Care (PPO), offering preventive services with no copay and no coinsurance, and Medicare-covered dental for a $35 copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $2,000 annual limit, though other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Care (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Value Care (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. These covered benefits feature no copays, and coinsurance ranges from no coinsurance up to 20% depending on the specific equipment or supply.
Diagnostic and Radiological Services See details
Aetna Medicare Value Care (PPO) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $65 copay for diagnostic tests, while radiological services feature no copay for outpatient X-rays and a minimum 20% coinsurance for therapeutic services.
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
Aetna Medicare Value Care (PPO) offers Cardiac Rehabilitation Services with no copay and no coinsurance, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Aetna Medicare Value Care (PPO) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. Patients 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
Other services are partially covered by Aetna Medicare Value Care (PPO), offering over-the-counter (OTC) items, annual wellness exams, screening mammographies, and additional colorectal screenings with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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