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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 Allegheny County. 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 $29.00. 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 $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 $9550.00 (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 $9550.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service for any supply length. If you use standard pharmacies or standard mail-order options, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply duration. For higher-tier medications, costs are based on coinsurance across all pharmacy and mail-order channels. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. Tier 3 and Tier 4 coinsurance rates apply to one, two, or three-month supplies, while Tier 5 specialty drugs are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive healthcare coverage with no copay and no coinsurance for primary care doctor visits, home health services, and most routine preventive care. Specialist visits are highly affordable, requiring no copay to a $30 copay, while inpatient hospital stays require a $275 copay per stay for acute care with no coinsurance. Emergency room visits carry a $130 copay and urgent care services require a $50 copay, both featuring no coinsurance. For supplemental benefits, the plan provides no copay options for routine dental cleanings, annual eye exams, and prescription hearing aids up to a $500 annual limit per ear. Vision hardware is covered with no copay up to a $400 annual limit, and comprehensive dental services require no copay with a 20% to 50% coinsurance up to a $1,250 yearly limit. Additionally, members benefit from an over-the-counter item allowance of up to $60 every three months with no copay.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute care requires a $275 copay per stay with no copay for unlimited additional days, while psychiatric care costs a $300 daily copay for days 1 to 5 and no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center (ASC) and blood services. Outpatient hospital services require a $0 to $250 copay, observation services carry a $250 copay per stay, and outpatient substance abuse sessions have a $20 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Plus (PPO) with no coinsurance and either no copay or a $145 copay. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services under the Aetna Medicare Value Plus (PPO) require prior authorization, with ground ambulance services carrying a $230 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Value Plus (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $130 to $230.
Primary Care See details
Aetna Medicare Value Plus (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with no copay to a $30 copay and no coinsurance. Physical, occupational, and speech therapy services require a $25 copay and no coinsurance, while chiropractic care is partially covered, offering routine care for a $15 copay and no coinsurance but excluding other chiropractic services.
Preventive Services See details
Preventive services under the Aetna Medicare Value Plus (PPO) are partially covered, with most services like annual physical exams and screenings requiring no copay and no coinsurance, though kidney disease education carries a 20% coinsurance and no copay. Several supplemental services are not covered under this plan, including in-home safety assessments, personal emergency response systems, weight management programs, and nutritional benefits.
Hearing Services See details
Aetna Medicare Value Plus (PPO) provides partially covered hearing services, as OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered. Medicare-covered exams require a $30 copay and no coinsurance, while routine exams, fitting evaluations, and covered prescription hearing aids (up to $500 per ear annually) have no copay and no coinsurance.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (PPO) with no deductibles and no coinsurance, featuring eye exams with a $0 to $30 copay and a $50 annual limit. Eyewear benefits, including contacts, eyeglasses, and upgrades, are covered with no copay up to a combined maximum of $400 every year.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Value Plus (PPO) plan, with Medicare-covered dental requiring a $30 copay and no coinsurance, and preventive services like cleanings and exams having no copay and no coinsurance. Comprehensive services feature no copay and 20% to 50% coinsurance up to a $1,250 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic services, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (PPO) with no copay and coinsurance ranging from no coinsurance up to 20% depending on the item. Prior authorization is required for these benefits, which include durable medical equipment, prosthetics, and diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (PPO) with no copay and no coinsurance for outpatient diagnostic procedures, tests, and lab services. Outpatient diagnostic radiological services also feature no copay, while outpatient X-rays require a $20 copay and therapeutic radiological services carry a 20% minimum coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Value Plus (PPO) plan. While the overall category features no copay and no coinsurance, all specific sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD), are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Aetna Medicare Value Plus (PPO) with no coinsurance, requiring a daily copayment of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a three-day prior inpatient hospital stay is not required, and additional days beyond the 100-day Medicare benefit period are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Value Plus (PPO) plan, featuring no copay and no coinsurance for eligible benefits such as chronic illness meals, select wellness exams, and over-the-counter items up to $60 every three months. Acupuncture is not covered under this benefit.
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