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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 Select Counties Across AL. 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 $23.30. 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 $13900.00 (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 $13900.00 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 enhanced alternative drug benefit with an annual prescription drug deductible of $615. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs when using preferred pharmacies or preferred mail order, or a $12 copay at standard pharmacies. Tier 2 standard generic drugs require a 22% coinsurance, while Tier 3 preferred brands and Tier 4 non-preferred drugs require a 25% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, beneficiaries who qualify for the low-income subsidy can receive a Part D premium reduction, paying $23.30.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits and most preventive services. For hospital care, acute inpatient stays require a $375 copay for days one through seven with no copay for additional days, while outpatient services feature no coinsurance and variable copays. Emergency room visits require a $115 copay that is waived if admitted, and ground ambulance services carry a $280 copay. This plan also includes supplemental benefits for dental, vision, and hearing care, offering no copays or coinsurance for routine exams and cleanings. Vision eyewear is covered with no copay up to a $250 annual limit, and comprehensive dental care is available with a 20% to 50% coinsurance up to a $2,500 yearly limit. Furthermore, diagnostic lab work and home health services require no copay or coinsurance, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) partially covers inpatient hospital benefits with no coinsurance required. Acute stays require a $375 copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays require a $678 copay for days 1 through 3 and no copay for days 4 through 90. Upgrades, non-Medicare-covered stays, and additional days for psychiatric hospitalizations are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance and copays ranging from $0 to $388 depending on the service. Patients pay a $375 copay per stay for observation services, a $40 copay for outpatient substance abuse sessions, and no copay for ambulatory surgical center or blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Value Plus (PPO) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under the Aetna Medicare Value Plus (PPO) plan, as transportation services to health-related locations are not covered. Ground ambulance services require a $280 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Aetna Medicare Value Plus (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $280.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Value Plus (PPO), as podiatry services and routine chiropractic care are not covered. Patients pay no copay and no coinsurance for primary care doctor visits, while other covered services like specialist, therapy, and mental health visits have copays ranging from $0 to $40 with no coinsurance. Additional telehealth services are covered with a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (PPO), with most covered benefits, such as annual physical exams, offering no copay and no coinsurance, while kidney disease education services require a 20% coinsurance and no copay. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, enhanced disease management, telemonitoring services, home and bathroom safety modifications, and counseling services.
Hearing Services See details
Aetna Medicare Value Plus (PPO) partially covers hearing services, offering Medicare-covered exams for a $30 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Up to $500 per ear annually is covered for general prescription hearing aids with no copay or coinsurance, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Plus (PPO) covers vision services with no coinsurance, offering eye exams for a $0 to $30 copay up to a $50 annual maximum. Eyewear, including lenses, frames, and contacts, is also covered with no copay and no coinsurance up to a $250 annual combined limit.
Dental Services See details
Aetna Medicare Value Plus (PPO) features partially covered dental services with no copay or coinsurance for routine exams, cleanings, and x-rays, and a $30 copay with no coinsurance for Medicare-covered dental care. Comprehensive services like restorative care and periodontics are covered with 20% to 50% coinsurance and no copay up to a $2,500 yearly limit, though fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (PPO) covers Home Infusion bundled Services, which require prior authorization. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Value Plus (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (PPO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies and therapeutic shoes are also covered with no copay and up to 20% coinsurance, and prior authorization is required for most equipment.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Value Plus (PPO) with prior authorization required. Lab services require no copay and no coinsurance, while diagnostic procedures and radiological services require copays ranging from $0 to $300 with no coinsurance. Therapeutic radiological services require a 20% coinsurance with 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. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Value Plus (PPO) and some services are covered, though Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered in practice. No copay or coinsurance details are applicable as these specific services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization with no coinsurance, no copay for days 1 to 20, and a $218 daily copay for days 21 to 100. Additional days beyond Medicare-covered SNF stays are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Value Plus (PPO) plan, with no copays or coinsurance for covered benefits such as meals for chronic illness and over-the-counter items up to a $60 quarterly limit. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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