A non-government entity
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 2026, 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 Davis, Iron, Salt Lake and Utah Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $37.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $8950.00 (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 $8950.00 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 Plus (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Value Plus (PPO) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when filling prescriptions through preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail-order services, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply length. Higher-tier medications under this plan require coinsurance instead of flat copays. Tier 3 preferred brand drugs have a 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance, with Tier 5 specialty prescriptions limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers robust coverage with no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. For specialized medical care, specialist visits require a copay of up to $35, while inpatient hospital stays require a $400 daily copay for the first five days of acute stays. Emergency room visits carry a $130 copay, which is waived upon admission within 24 hours, and urgent care services require a $45 copay. For ancillary benefits, preventive dental care, routine vision exams, and hearing exams are available with no copays or coinsurance, including up to a $1,000 annual hearing aid allowance per ear and a $150 annual eyewear allowance. Diagnostic lab tests and outpatient x-rays also feature no copay, while dialysis and durable medical equipment require a 20% coinsurance. Additionally, the plan provides an over-the-counter item allowance of $20 every three months with no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Value Plus (PPO) with no coinsurance, requiring a $400 daily copay for days 1 to 5 of acute stays and a $370 daily copay for days 1 to 5 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copays. Outpatient hospital services require a copay of $0 to $400 (with a $400 copay per stay for observation services), while outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (PPO) partially covers ambulance and transportation services, as transportation services to any health-related locations are not covered. Covered ground ambulance services require a $240 copay and coinsurance, while air ambulance services require a copay and 20% coinsurance, with prior authorization required for all ambulance services.
Emergency Services See details
Emergency Services under the Aetna Medicare Value Plus (PPO) are covered with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $45 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $130 to $240, up to a $250,000 maximum benefit.
Primary Care See details
Aetna Medicare Value Plus (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy, mental health, and psychiatric services require copays up to $35 and no coinsurance. Podiatry and routine chiropractic services are not covered, but telehealth benefits are available with a $0 to $45 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Value Plus (PPO) plan, featuring no copay and no coinsurance for annual physicals, health education, and fitness benefits, while kidney disease education requires a 20% coinsurance and no copay. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional or dietary benefits, home-based palliative care, in-home support services, support for caregivers, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Plus (PPO), featuring no copays, no coinsurance, and no deductibles for Medicare-covered exams, annual routine exams, and fitting evaluations. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (PPO) with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This includes one routine eye exam per year up to a $50 annual limit, and a combined $150 annual allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (PPO), with preventive care like exams, cleanings, and x-rays requiring no copay and no coinsurance, and Medicare-covered dental requiring a $35 copay and no coinsurance. Covered comprehensive services—including restorative, endodontics, periodontics, prosthodontics, oral surgery, and adjunctive services—have no copay and 20% to 50% coinsurance up to a $1,000 annual maximum. Fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Value Plus (PPO) plan, with prior authorization required for services. Diagnostic tests, lab services, outpatient x-rays, and diagnostic radiological services are covered with no copay and no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Value Plus (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 by Aetna Medicare Value Plus (PPO) with no coinsurance, though in practice only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require copays of $15 to $20.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and days beyond the standard 100-day limit are not covered. Patients pay a $10 copay per day for days 1 through 20 and a $218 copay per day for days 21 through 100, with no prior three-day inpatient hospital stay required.
Other Services See details
Aetna Medicare Value Plus (PPO) partially covers other services with no copay and no coinsurance for annual wellness exams, screening mammographies, and over-the-counter items up to $20 every three months. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved