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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 in KY. 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 $38.40. 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 $8950.00 (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 $8950.00 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 an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail-order service. If you fill these generic prescriptions at a standard pharmacy or standard mail-order service, copays start at $2.00 for Tier 1 and $12.00 for Tier 2 for a one-month supply. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand-name drugs have a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy options. These cost-sharing percentages apply whether you use preferred or standard pharmacies, or mail-order delivery services.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, while specialist consultations range from no copay to a $35 copay. For hospital stays, members pay a $285 daily copay for the first six days of inpatient care and no copay for days seven through 90. Emergency room visits require a $130 copay, which is waived upon admission, and urgently needed services are available for a $50 copay with no coinsurance. Routine preventive care, annual physicals, and home health services are fully covered with no copay and no coinsurance. This plan also includes valuable dental, vision, and hearing benefits, featuring no copay for preventive dental care, a $250 annual eyewear allowance, and up to a $1,000 annual prescription hearing aid allowance per ear. Eligible diagnostic lab services and over-the-counter items are also covered with no copay, helping to keep out-of-pocket healthcare costs predictable.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $285 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and while unlimited additional acute care days are covered with no copay, 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, including outpatient hospital services with a $0 to $285 copay and observation services with a $285 copay per stay. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions carry a $40 copay with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Value Plus (PPO), offering ground ambulance services with a $285 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Value Plus (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 have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $285.
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 $35 copay and no coinsurance. Other services like physical therapy and mental health sessions have copays ranging from $30 to $40 with no coinsurance, though chiropractic services are only partially covered as routine chiropractic care and other chiropractic 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, health education, and screenings requiring no copay and no coinsurance, while kidney disease education has no copay but a 20% coinsurance. Not covered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 safety devices, and counseling.
Hearing Services See details
Aetna Medicare Value Plus (PPO) hearing services include Medicare-covered exams for a $35 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 annual limit per ear, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services covered by the Aetna Medicare Value Plus (PPO) feature eye exams with a $0 to $35 copay and eyewear with no copay, with no coinsurance or deductibles required for either. The plan provides up to a $50 annual benefit for eye exams and a $250 annual allowance for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Value Plus (PPO), featuring no copay and no coinsurance for preventive care, a $35 copay and no coinsurance for Medicare-covered dental, and no copay with 20% to 50% coinsurance for comprehensive care up to a $1,500 annual limit. Fluoride treatments, implant services, orthodontics, maxillofacial prosthetics, other diagnostic dental, and other preventive dental services 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. Medicare Part B insulin drugs feature 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
Aetna Medicare Value Plus (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. These covered services feature no copays, with coinsurance ranging 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 Plus (PPO) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $50 copay for procedures. Radiological services include a $20 copay plus coinsurance for X-rays, a minimum 20% coinsurance for therapeutic services, and a minimum $0 copay for diagnostic radiology.
Home Health Services See details
Aetna Medicare Value Plus (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Aetna Medicare Value Plus (PPO) with no coinsurance, though only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered, but they require a $10 copay when services are rendered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copayment 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 period are not covered.
Other Services See details
Aetna Medicare Value Plus (PPO) partially covers other services, offering over-the-counter (OTC) items, annual wellness exams, and additional screenings with no copay and no coinsurance. Acupuncture, meal benefits, and other services are not covered under this plan.
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