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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 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 Rhode Island. 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 $26.20. 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 $9500.00 (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 $9500.00 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 features an annual drug deductible of $615. For generic medications, this plan offers excellent cost savings, featuring no copay for Tier 1 preferred generics and Tier 2 generics when filled at a preferred pharmacy or through preferred mail order. If you use standard pharmacies or standard mail order, Tier 1 drugs carry a low copay starting at $2.00, while Tier 2 drugs start at a $12.00 copay for a one-month supply. For higher-tier medications, costs transition to coinsurance percentages instead of flat copays. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and most preventive services. For specialized medical needs, members pay low copays with no coinsurance, such as a $35 copay for specialist visits and a $130 copay for emergency room care. Inpatient hospital stays require daily copays for the first seven days, after which there is no copay for additional days. This PPO plan also includes valuable dental, vision, and hearing benefits with no deductibles and no coinsurance for routine services. Members enjoy no copay for preventive dental care up to a $2,000 annual limit, a $200 yearly allowance for eyewear, and no copay for routine hearing exams. Additionally, the plan provides extra perks like a $45 quarterly over-the-counter item allowance and chronic illness meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for acute days 1-7 (and no copay for days 8 and beyond) and a $275 daily copay for psychiatric days 1-7 (and no copay for days 8-90). Prior authorization is required for these services, 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 copay and no coinsurance. Outpatient hospital services require a copay of $0 to $295, observation services carry a $325 copay per stay, and outpatient substance abuse sessions have a $35 copay, all with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with a copay of $70.00 or $145.00 and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (PPO) covers ground ambulance services with a $280 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Aetna Medicare Value Plus (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgent care with a $35 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum with no coinsurance and copays of $130 for emergency or urgent care and $280 for transportation.
Primary Care See details
Aetna Medicare Value Plus (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist, mental health, and therapy services require copays ranging from $0 to $35 and no coinsurance. Telehealth services require a 20% coinsurance and a $0 to $35 copay, but routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Plus (PPO), with most covered services like annual physicals and screenings requiring no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Sub-services not covered 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/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Plus (PPO), featuring no coinsurance and no deductible for all covered care. Medicare-covered exams require a $35 copay, while annual routine exams and fitting evaluations have no copay; prescription hearing aids are covered with copays between $0 and $1,700, but 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 deductible, no coinsurance, and copays ranging from no copay to $35 for eye exams, including one routine exam per year with no copay. Eyewear is also covered with no copay or coinsurance up to a combined maximum benefit of $200 annually for contacts, lenses, and frames.
Dental Services See details
Dental Services covered under the Aetna Medicare Value Plus (PPO) plan include Medicare-covered dental services for a $35 copay and no coinsurance, as well as preventive and comprehensive dental services with no copay and no coinsurance up to a $2,000 annual limit. This benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry 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 under the Aetna Medicare Value Plus (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Value Plus (PPO) with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. Coinsurance ranges from no coinsurance to 25% for DME and medical supplies, no coinsurance to 20% for diabetic supplies, and is a flat 25% for prosthetic devices.
Diagnostic and Radiological Services See details
Aetna Medicare Value Plus (PPO) covers diagnostic and radiological services with prior authorization required, featuring no copay to a $35 copay plus coinsurance for diagnostic tests, and a copay with no coinsurance for lab services. Diagnostic radiological services have no copay, outpatient X-rays require a $10 copay plus coinsurance, and therapeutic radiological services carry a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Value Plus (PPO) provides coverage for cardiac rehabilitation services with no coinsurance, though in practice only some services are covered. The plan does not cover cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, or supervised exercise therapy (SET) for peripheral artery disease (PAD), which require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $210 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services for the Aetna Medicare Value Plus (PPO) are partially covered, offering no copay and no coinsurance for covered benefits like annual wellness exams, chronic illness meal benefits, and up to $45 every three months in over-the-counter item reimbursements. Acupuncture is not covered under this plan.
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