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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 LA - 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 $25.00. 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 $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 the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay when using a preferred pharmacy or preferred mail order, but have a $12 copay at a standard pharmacy or standard mail order. After your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you may pay a reduced premium.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. The plan also provides coverage for primary care, preventive, hearing, vision, and dental services, with specific copays and annual maximums for certain benefits like dental. Additionally, the plan covers emergency services, ambulance services, and home health services, as well as medical equipment, diagnostic, and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $380 for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $407 for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Aetna Medicare Value Plus (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $380, and observation services with a $380 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while outpatient substance abuse services have a $40 copay 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. You will pay an $80 copay for this benefit.
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; however, 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, and Urgently Needed Services have a $40 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and 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. Chiropractic services have a $15 copay, while occupational therapy services have a $35 copay. Physician specialist services have a copay between $0 and $40, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services each have a $40 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Other health care professionals have a copay between $0 and $40.
Preventive Services See details
Preventive services include annual physical exams with no copay, and other services like health education, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and wigs for hair loss related to chemotherapy, all with a $0 copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
The Aetna Medicare Value Plus (PPO) plan covers hearing exams with a $40 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered with a maximum benefit of $500 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay between $0 and $40, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, but there is a combined maximum benefit of $100 every year.
Dental Services See details
Dental services are covered under the Aetna Medicare Value Plus (PPO) plan, with a $1,000 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. However, 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 and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
The Aetna Medicare Value Plus (PPO) plan covers medical equipment, including Durable Medical Equipment (DME), with a 19% coinsurance and requires authorization. Prosthetics/Medical Supplies - Non-Medicare benefit, Prosthetic Devices, and Medical Supplies are covered, with a 19% coinsurance. Diabetic Equipment is covered, with a coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts, and a copay for Medicare-covered Diabetes Supplies.
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), lab services (with no copay), and all radiological services. Therapeutic Radiological Services have a coinsurance of at least 20%, and Diagnostic Radiological Services have a maximum copay of $300. Outpatient X-Ray Services have no 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. Authorization is required for this benefit.
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) benefits are covered by the Aetna Medicare Value Plus (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for over-the-counter items and meal benefits with no copay, while acupuncture is not covered. The plan offers an OTC benefit with a maximum of $15 every three months. Other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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