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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 Knoxville Tennessee. 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 $11.00. 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 $250.00 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 $7750.00 (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 $7750.00 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 $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you'll pay a $10 copay at a preferred pharmacy. For standard generic drugs, you'll pay 25% coinsurance, and for preferred brand drugs, you'll pay 26% coinsurance. After your total drug costs reach $2,000, you will enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the specific service. You'll find no copays for primary care, preventive services like annual exams, and many dental services. The plan also covers hearing and vision services with copays and offers coverage for medical equipment and home health services. This plan provides specific copays for services like emergency care, ambulance, and specialist visits. It also includes coverage for home infusion services, dialysis, and skilled nursing facility stays. However, some services like cardiac rehabilitation, certain dental procedures, and specific vision and hearing aid options, are not covered.
Inpatient Hospital See details
The Aetna Medicare Value Plus (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $374 copay for days 1-8, and no copay for days 9-90; Inpatient Hospital Psychiatric has a $286 copay for days 1-8, and no copay for days 9-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, with a copay of $0-$374.00, and observation services with a copay of $374.00. The plan also covers ambulatory surgical center services with no copay, outpatient substance abuse services with a copay of $40, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. You will have a $105 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (PPO), with prior authorization required for all ambulance services. Ground Ambulance Services have a $275 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, including Worldwide Emergency Services, are covered under the Aetna Medicare Value Plus (PPO) plan. For Emergency Services and Worldwide Emergency Coverage, there is a $125 copay, and for Worldwide Emergency Transportation, there is a $275 copay; Urgently Needed Services have a $50 copay, and 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 chiropractic services with a $15 copay. Occupational therapy services have a $30 copay, while physician specialist services have a $35 copay. Mental health and psychiatric services, and opioid treatment program services have a $40 copay, and physical therapy and speech-language pathology services have a $30 copay. Other health care professional services have a copay between $0 and $35. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $50. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for services like annual physical exams, with no copay. Other services, such as health education, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, are covered with no copay. Kidney disease education services have a 20% coinsurance. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Aetna Medicare Value Plus (PPO) covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are partially covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Aetna Medicare Value Plus (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay and a combined maximum benefit of $100 per year. Routine eye exams are covered with no copay for one visit per year.
Dental Services See details
Dental Services are covered, with a $1,000 annual maximum. 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. Medicare dental services require a $35 copay. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%. Prior authorization is required.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Value Plus (PPO) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, and Medicare-covered Diabetic Supplies have a copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with a copay that ranges from $0 to $100, and no copay for lab services. Diagnostic Radiological Services have a copay up to $200, while Outpatient X-Ray Services have a $14 copay, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered 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. No copay or coinsurance information is available for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (PPO) plan, requiring prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan covers over-the-counter items with no copay, and a maximum benefit of $45 every three months. The plan does not cover 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, or Self-Directed Personal Assistance Services.
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