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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 2026 to people living in Maricopa, Pima and Pinal Counties. 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 $15.90. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $8900.00 (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 $8900.00 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 enhanced alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will enjoy no copay for tier 1 preferred generic drugs at preferred pharmacies and preferred mail order services, or a $12.00 copay at standard pharmacies and standard mail. Other tiers require coinsurance, including 22% for tier 2 standard generics and 25% for both tier 3 preferred brands and tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, individuals who qualify for the low-income subsidy will pay a reduced Part D premium of $15.90. This plan offers a clear cost-sharing structure to help you anticipate and manage your prescription medication costs.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers affordable access to core healthcare services, featuring no copay or coinsurance for primary care visits, preventive care, and home health services. For hospital stays, members pay a $375 daily copay for the first few days of inpatient care, while outpatient services range from no copay for ambulatory surgery to a $375 copay for hospital visits. Emergency care is available with a $130 copay, which is waived if admitted, and skilled nursing facility stays require no copay for the first 20 days. Essential wellness benefits like routine vision, hearing, and preventive dental care are fully covered with no copay or coinsurance, including allowances for eyewear and hearing aids. For specialized medical needs, diagnostic lab services and medical equipment feature no copays, though durable medical equipment and dialysis require up to a 20% coinsurance. Additionally, the plan provides a $30 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Aetna Medicare Value Care (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for additional days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under Aetna Medicare Value Care (PPO) with no coinsurance, featuring no copayments for ambulatory surgical center and outpatient blood services. Other covered services require copays, including $40 for outpatient substance abuse sessions, $375 per stay for observation services, and $0 to $375 for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Value Care (PPO) with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by the Aetna Medicare Value Care (PPO) plan, as transportation services to health-related locations are not covered. Covered ground ambulance services require a $295 copay and no coinsurance, while covered air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Aetna Medicare Value Care (PPO) covers emergency services with a $130 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered under a $50 copay and no coinsurance, while worldwide emergency services are covered up to $250,000 with copays ranging from $130 to $295.
Primary Care See details
Aetna Medicare Value Care (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $40 copay. Chiropractic care is partially covered with a $15 copay, excluding routine care, but podiatry services are not covered. Additional telehealth benefits are available with a 20% coinsurance and copays ranging from no copay to $50.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Care (PPO), featuring no copay and no coinsurance for annual physicals, fitness benefits, wigs, and screenings, while kidney disease education requires a 20% coinsurance and no copay. Sub-services not covered 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, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Care (PPO), featuring routine hearing exams and fitting evaluations with no copay or coinsurance. Covered prescription hearing aids also have no copay or coinsurance up to a $1,000 annual maximum per ear, but 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 Care (PPO) covers vision services with no copay and no coinsurance, including eye exams and eyewear. The plan provides up to $50 annually for eye exams, with routine exams limited to one visit per year, and a combined annual eyewear allowance of $150.
Dental Services See details
Aetna Medicare Value Care (PPO) offers partially covered dental services, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Preventive care like exams and cleanings has no copay and no coinsurance, Medicare-covered dental services require a $40 copay and no coinsurance, and covered comprehensive services have no copay and 20% to 50% coinsurance up to a $1,000 annual maximum.
Home Infusion bundled Services See details
Aetna Medicare Value Care (PPO) covers home infusion bundled services with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Aetna Medicare Value Care (PPO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Value Care (PPO) plan, featuring no copays for all covered items. Coinsurance ranges from no coinsurance to 20% for durable medical equipment, medical supplies, and diabetic supplies, while prosthetic devices require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Value Care (PPO) plan, requiring prior authorization. Lab services have no copay, diagnostic procedures range from a $0 to $20 copay, diagnostic radiology ranges from a $0 to $160 copay, and outpatient X-rays cost a $20 copay (all with no coinsurance), while therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Care (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Value Care (PPO) plan. This lack of coverage applies to all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Value Care (PPO) with no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance. The benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, and prior authorization is required.
Other Services See details
Other Services are partially covered by Aetna Medicare Value Care (PPO) with no copay and no coinsurance for covered benefits, which include a $30 quarterly over-the-counter item reimbursement, annual wellness exams, and additional colorectal screenings. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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