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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 MS. 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 $23.80. 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 annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for a one- to three-month supply when using preferred pharmacies or preferred mail-order services. If standard pharmacies or standard mail-order services are used, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. Higher-tier medications transition to coinsurance, with Tier 3 preferred brand drugs requiring a 22% coinsurance across all pharmacy and mail-order options. Both Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance, with specialty medications limited to a one-month supply. This plan structure allows you to estimate your out-of-pocket prescription expenses based on your specific medication tier.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive medical coverage with no copay for primary care visits and a copay of $0 to $40 for specialist consultations. For hospital stays, members pay no coinsurance, with inpatient acute care requiring a $388 daily copay for the first seven days and outpatient services featuring copays ranging from no copay up to $450. Emergency care is accessible with a $115 copay, which is waived if admitted, while urgent care services require a $40 copay. This plan also includes valuable supplemental benefits, such as preventive dental, routine vision, and annual hearing exams with no copay and no coinsurance. Members receive a $300 annual eyewear allowance and up to $500 per ear for prescription hearing aids, alongside a $75 quarterly allowance for over-the-counter items. Additionally, home health services and skilled nursing facility care for the first 20 days are covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) covers inpatient hospital services with no coinsurance, requiring a $388 daily copay for days 1 to 7 of acute stays and a $678 daily copay for days 1 to 3 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and certain services such as 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, featuring copays ranging from $0 to $450 for outpatient hospital services and a $388 copay per stay for observation services. Ambulatory surgical and outpatient blood services have no copay, while outpatient substance abuse sessions require a $40 copay with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (PPO) covers ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to plan-approved or any other health-related locations are not covered.
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 are covered with a $40 copay and no coinsurance, while worldwide emergency services feature no coinsurance and copays of $115 for emergency or urgent care and $295 for transportation, up to a $250,000 maximum benefit.
Primary Care See details
Aetna Medicare Value Plus (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay with no coinsurance, while telehealth services have a $0 to $40 copay and 20% coinsurance. Mental health, psychiatric, and opioid treatments carry a $40 copay with no coinsurance, whereas podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Plus (PPO), with no copay and no coinsurance for annual physical exams, fitness benefits, and glaucoma screenings. Kidney disease education is covered with no copay and a 20% coinsurance, while several services—including in-home safety assessments, personal emergency response systems, and weight management programs—are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Plus (PPO), with Medicare-covered exams requiring a $40 copay and no coinsurance, and annual routine exams and fitting evaluations requiring no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Plus (PPO) covers vision services with no deductible and no coinsurance. Routine eye exams and eyewear, including contacts and eyeglasses, feature no copay, while Medicare-covered eye exams have a copay of $0 to $40. Annual benefits include up to $50 for exams and a combined $300 allowance for eyewear.
Dental Services See details
Aetna Medicare Value Plus (PPO) offers partially covered dental services, featuring Medicare-covered dental for a $40 copay and no coinsurance, alongside preventive cleanings, exams, and x-rays with no copay and no coinsurance. Comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $2,000 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance with no copay.
Dialysis Services See details
Aetna Medicare Value Plus (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers durable medical equipment (DME) and prosthetics with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts have no copay, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (PPO) with prior authorization required. Diagnostic tests and lab services feature no coinsurance, with lab services and outpatient X-rays requiring no copay, diagnostic procedures costing a $0 to $95 copay, and therapeutic radiological services carrying a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Value Plus (PPO) plan, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Plus (PPO) partially covers other services, with acupuncture and Dual Eligible SNPs with Highly Integrated Services not covered. Covered benefits—including a $75 quarterly over-the-counter item allowance, chronic illness meals, annual wellness exams, and additional gFOBT and FIT screenings—are available with no copay and no coinsurance.
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