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Aetna Medicare Value Care (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Care (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 Care (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Value Care (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IN Northeast, IN Northwest. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Value Care (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 Care (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 Care (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.00. 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 $10100.00 (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 $10100.00 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:
Sign up for Aetna Medicare Value Care (PPO)
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Drug Coverage
The Aetna Medicare Value Care (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when utilizing preferred retail pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail order, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. For higher-tier medications, cost-sharing is structured as coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail-order networks. This percentage-based cost sharing remains the same whether you use preferred or standard prescription services.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers affordable access to essential medical services, featuring no copay and no coinsurance for primary care doctor visits and annual physicals. Specialist visits require a $30 copay, while emergency room care is available with a $130 copay that is waived if you are admitted within 24 hours. For hospital stays, inpatient care requires a $365 daily copay for the first eight days with no copay thereafter, while outpatient hospital services range from no copay up to a $365 copay. This plan also includes valuable everyday wellness benefits, such as routine dental, vision, and hearing exams with no copays. Prescription hearing aids are covered up to $750 per ear annually, and you receive up to $150 yearly for eyewear and a $15 quarterly allowance for over-the-counter items. Additionally, preventive dental care has no copay, while comprehensive dental services are covered with no copay and a 20% to 50% coinsurance up to a $1,250 annual limit.
Inpatient Hospital See details
Aetna Medicare Value Care (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute stays require a $365 daily copay for days 1-8 and no copay thereafter, while psychiatric stays require a $325 daily copay for days 1-7 and no copay thereafter; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Care (PPO) covers outpatient services with no coinsurance, featuring a $0 to $365 copay for outpatient hospital services and a $365 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Care (PPO) covers partial hospitalization services with a copay of either $75.00 or $145.00 and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (PPO) covers ambulance services with prior authorization, requiring a $295 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport, neither of which is waived if you are admitted to the hospital. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Value Care (PPO) covers emergency services with a $130 copay (waived if admitted 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 limit with no coinsurance, featuring copays of $130 for emergency or urgent care and $295 for transportation.
Primary Care See details
Aetna Medicare Value Care (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, while telehealth services range from a $0 to $40 copay with 20% coinsurance. Podiatry is not covered, and chiropractic services have some services covered but routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Care (PPO), offering no copay and no coinsurance for annual physicals, health education, fitness benefits, remote access, and routine screenings, while kidney disease education has no copay and a 20% coinsurance. Excluded services that are not covered include in-home safety assessments, PERS, medical nutrition therapy, 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/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Value Care (PPO), which offers Medicare-covered exams for a $30 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 maximum benefit per ear annually, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Care (PPO) covers vision services with no coinsurance and no deductible, offering routine eye exams with no copay (up to one yearly, with a $50 maximum benefit) and Medicare-covered exams with a $0 to $30 copay. Eyewear, including contacts and eyeglasses, is also covered with no copay up to a combined annual limit of $150.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Value Care (PPO) plan, featuring a $30 copay and no coinsurance for Medicare-covered dental, no copay and no coinsurance for preventive care, and no copay with 20% to 50% coinsurance for comprehensive services up to a $1,250 annual maximum. Fluoride treatments, other diagnostic or preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Care (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Care (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays. Coinsurance for these covered items ranges from no coinsurance up to 20% depending on the service, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Care (PPO), with prior authorization required for all services. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $75 copay for diagnostic tests. Radiological services require a $20 copay for outpatient X-rays, no copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Aetna Medicare Value Care (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 technically covered under Aetna Medicare Value Care (PPO) with no coinsurance, but in practice only some services are covered. The services that are not covered include cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Care (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 three-day prior inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Value Care (PPO), offering no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT, and up to $15 every three months in over-the-counter (OTC) item reimbursements. Acupuncture and meal benefits are not covered.
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