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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 Colorado. 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 $34.00. 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 $10000.00 (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 $10000.00 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 drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when utilizing preferred pharmacies or preferred mail order services. If you use standard pharmacies or standard mail order, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the prescription fill length. For higher-tier medications, cost-sharing is structured as coinsurance rather than flat copays. Tier 3 preferred brand-name drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance percentages remain the same whether you fill your prescriptions at a preferred pharmacy, standard pharmacy, or via mail order.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan provides comprehensive medical coverage with no copay for primary care visits and a $35 copay for specialist consultations. For hospital stays, members pay a $350 daily copay for the first six days of acute inpatient care and no copay for subsequent days, while emergency room visits require a $130 copay which is waived if admitted. Outpatient hospital services feature a copay ranging from no copay up to $350 with no coinsurance, and home health services are available with no copay or coinsurance. This plan also includes valuable everyday wellness benefits, such as routine hearing and vision exams with no copay, alongside annual allowances of $1,250 for hearing aids and $200 for eyewear. Preventive dental care requires no copay, while comprehensive dental services are covered with no copay and a 20% to 50% coinsurance up to a $2,000 yearly limit. Additionally, members benefit from a $30 quarterly over-the-counter allowance and skilled nursing facility stays that feature no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Value Care (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring prior authorization for stays. For acute care, you pay a $350 daily copay for days 1 through 6 and no copay for subsequent unlimited days, while psychiatric care costs a $370 daily copay for days 1 through 5 and no copay for days 6 through 90. Non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Care (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $350 for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Care (PPO) with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by the Aetna Medicare Value Care (PPO) plan with a $245 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport, though prior authorization is required. Transportation services to plan-approved or other 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. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $130 to $245.
Primary Care See details
Aetna Medicare Value Care (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and physical therapy require a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $40 copay and no coinsurance, but chiropractic and podiatry services are not covered. Telehealth services are also available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Value Care (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physicals, health education, and screenings, while kidney disease education requires a 20% coinsurance and no copay. Sub-services not covered under this benefit include in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Value Care (PPO), featuring hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered with no copay or coinsurance up to a $1,250 annual limit, but OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Care (PPO) covers vision services 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 maximum) and a $200 combined annual maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Value Care (PPO) partially covers dental services, featuring preventive care with no copay and no coinsurance, and Medicare-covered dental with a $35 copay and no coinsurance. Comprehensive services like restorative and endodontics are covered with no copay and 20% to 50% coinsurance up to a $2,000 yearly limit, while 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. Covered 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 Care (PPO) plan 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, prosthetics, and diabetic supplies, with no copay and prior authorization required. Coinsurance for these services ranges from no coinsurance up to 20% depending on the specific item.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Value Care (PPO), with diagnostic services requiring prior authorization, no coinsurance, and copays ranging from no copay up to $20. Radiological services also require prior authorization and feature no copay for diagnostic radiology, a $10 copay with coinsurance for outpatient X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Value Care (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no copay and no coinsurance under the Aetna Medicare Value Care (PPO), meaning some services are covered. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Aetna Medicare Value Care (PPO) with no coinsurance, as additional days beyond the standard Medicare limit are not covered. Covered stays require prior authorization but no prior hospital stay, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Other services under the Aetna Medicare Value Care (PPO) are partially covered with no copay and no coinsurance, including chronic illness meals, annual wellness exams, screening mammography, additional gFOBT and FIT, and a $30 quarterly over-the-counter allowance. Acupuncture is not covered under this plan.
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