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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 2025, 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 MS - Statewide. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $40.50. 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 $590.00 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 $14000.00 (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 $14000.00 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 has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay no copay at preferred pharmacies and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive coverage with a variety of benefits. This plan covers inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a copay. The plan also includes benefits for primary care, preventive care, hearing, vision, and dental services, often with no copay or a low copay. Additionally, this plan covers medical equipment, home health services, and skilled nursing facility services with a copay or coinsurance in some instances.
Inpatient Hospital See details
Inpatient Hospital benefits for the Aetna Medicare Value Plus (PPO) plan include coverage for Inpatient Hospital-Acute, with a copay of $380 for days 1-7 and no copay for days 8-90, and Inpatient Hospital Psychiatric, with a copay of $678 for days 1-3 and no copay for days 4-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $380, and observation services have a $380 copay. Ambulatory Surgical Center services and outpatient blood services have no copay, and outpatient substance abuse individual and group sessions have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. You will have an $80 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (PPO). Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Value Plus (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $295 copay. There is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Value Plus (PPO) plan covers primary care physician services with no copay, and chiropractor services with a $15 copay. Occupational therapy services have a $20 copay, and physical therapy and speech-language pathology services have a $20 copay. Physician specialist services have a copay between $0 and $20. Mental health and psychiatric services, and opioid treatment program services, each have a $40 copay for individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services are covered with no copay.
Hearing Services See details
The Aetna Medicare Value Plus (PPO) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per ear per year, and Prescription Hearing Aids (all types) are covered with no copay, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, along with OTC hearing aids.
Vision Services See details
The Aetna Medicare Value Plus (PPO) plan covers vision services, including eye exams with a copay of $0-$20, and eyewear with no copay, up to a combined maximum of $315 per year for both in-network and out-of-network services. Routine eye exams are covered with no copay, and other eye exam services and eyewear such as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, and other dental services, with a maximum plan benefit of $2,000 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Value Plus (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment are covered under the Aetna Medicare Value Plus (PPO) plan. Durable medical equipment has a 20% coinsurance, and durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have between 0% and 20% coinsurance, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $95, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay up to $300, therapeutic radiological services with at least 20% coinsurance, and outpatient X-Ray services 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; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value Plus (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (PPO) plan, requiring prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services with the Aetna Medicare Value Plus (PPO) plan include OTC items, meal benefits, and other services with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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