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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 LA Parishes. 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 $32.90. 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 $13900.00 (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 $13900.00 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 features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using a preferred pharmacy or preferred mail-order service. If you use a standard retail pharmacy or standard mail order, Tier 1 copays range from $2 to $6 and Tier 2 copays range from $12 to $36 depending on the supply fill. Higher-tier prescription medications under this plan require coinsurance rather than flat copays. Tier 3 preferred brand drugs have a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance percentages remain consistent across preferred and standard pharmacies, as well as mail-order options.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers robust healthcare coverage featuring no copay for primary care visits and low copays ranging from $0 to $35 for specialists. Inpatient hospital stays require a $388 daily copay for the first seven days with no coinsurance, while emergency room visits carry a $115 copay that is waived upon immediate admission. Outpatient hospital services are covered with no coinsurance and copays ranging from $0 to $450. In addition to medical care, the plan provides valuable dental, vision, and hearing benefits to lower your out-of-pocket costs. Members enjoy no copays for preventive dental services, routine vision exams, and routine hearing tests, alongside a $1,500 annual dental limit and a $200 annual eyewear allowance. Prescription hearing aids are covered up to $500 per ear annually, and the plan includes a $30 quarterly allowance for over-the-counter health products.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Value Plus (PPO) with no coinsurance, requiring a $388 daily copay for days 1-7 of acute stays and a $407 daily copay for days 1-5 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $450, observation services carry a $388 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (PPO) covers ground ambulance services with a $315 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Aetna Medicare Value Plus (PPO) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $315.
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. Covered therapy and mental health services have copays ranging from $35 to $45 with no coinsurance, while podiatry is not covered, and for chiropractic services, some services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (PPO), with most covered services—such as annual exams, fitness benefits, and health education—having no copay and no coinsurance, though kidney disease education carries a 20% coinsurance and no copay. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge 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 safety devices, and counseling.
Hearing Services See details
Aetna Medicare Value Plus (PPO) covers Medicare-covered hearing exams for a $35 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Plus (PPO) covers vision services with no coinsurance, featuring a $0 to $35 copay for eye exams and no copay for eyewear. Covered benefits include one routine eye exam per year with a $50 maximum limit, and a $200 combined annual maximum for contact lenses, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Aetna Medicare Value Plus (PPO) partially covers dental services up to a $1,500 annual limit, with a $35 copay and no coinsurance for Medicare-covered dental, no copay and no coinsurance for preventive services, and no copay with 20% to 50% coinsurance for comprehensive care. Fluoride, other diagnostic or preventive dental, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Aetna Medicare Value Plus (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (PPO), with durable medical equipment and prosthetics requiring no copay and a 20% coinsurance. Diabetic supplies feature no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Value Plus (PPO) with prior authorization required. Outpatient diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, while lab services have no copay and no coinsurance. Diagnostic radiological services have a copay starting at $0, outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Value Plus (PPO) does not cover Cardiac Rehabilitation Services, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services under the Aetna Medicare Value Plus (PPO) are partially covered, featuring no copay and no coinsurance for chronic illness meal benefits, annual wellness exams, screening mammographies, additional colorectal screenings, and up to $30 every three months in over-the-counter (OTC) item reimbursements. Acupuncture is not covered under this plan.
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