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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 IN Northeast, IN Northwest. 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 $28.00. 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 $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 $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:
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Drug Coverage
The Aetna Medicare Value Plus (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after the deductible, you'll pay a $0 copay for preferred generic drugs at preferred and mail-order pharmacies, and a $12 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 22% or 25% coinsurance depending on the tier. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers coverage for a variety of services. This includes inpatient hospital stays with copays ranging from $0 to $365, outpatient services with copays from $0 to $365, and emergency services with copays from $35 to $125. You'll also have access to no copay for primary care, preventive services, and dental services like oral exams. Additional benefits include coverage for hearing and vision services, with copays for exams and some hearing aids. The plan also covers home health services, skilled nursing facilities, and durable medical equipment with varying copays and coinsurance. Please note that some services, such as cardiac rehabilitation and certain other services, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $365 copay for days 1-8, and no copay for days 9-90; for Inpatient Hospital Psychiatric, you'll pay a $325 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $365, and observation services with a $365 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay of $75 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. The copay for this benefit is $75.
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, and 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Urgent Coverage has a $125 copay, Worldwide Emergency Transportation has a $295 copay, and Urgently Needed Services has a $35 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, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, and other health care professionals are covered with a copay between $0-$20. Additional telehealth benefits have a 20% coinsurance and a copay between $0-$75, and opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including annual physical exams with no copay. Kidney disease education services have a 20% coinsurance. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits, have no copay.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum plan benefit coverage of $750 per ear every year, and the plan doesn't cover prescription hearing aids for the inner ear, outer ear, or over the ear.
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. Eyewear has a combined maximum plan benefit coverage of $245 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Value Plus (PPO) plan covers dental services, including Medicare dental services with a $20 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Orthodontic services are covered up to a $1500 maximum. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will be responsible for 20% coinsurance.
Medical Equipment See details
The Aetna Medicare Value Plus (PPO) plan covers Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $75, and lab services with no copay. Radiological services are covered, with coinsurance for Medicare-covered X-Ray services, and diagnostic radiological services with a copay up to $275. Therapeutic radiological services have at least 20% coinsurance, and outpatient X-rays have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance, but 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. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and 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, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items and meal benefits are covered with no copay. Other services, including annual wellness exams, screening mammography, gFOBT, and FIT, are covered with no copay.
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