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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 Western Pennsylvania. 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 $13.00. 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 $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) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay varying costs depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at preferred and mail-order pharmacies, while standard generic drugs have a 24% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), you may have a reduced premium of $13.00 per month.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers a range of benefits with varying cost-sharing options. You can expect no copays for primary care visits, many preventive services, routine eye exams, and dental services, including exams and cleanings. The plan includes copays for inpatient hospital stays, outpatient services, specialist visits, and some other services, and also covers prescription hearing aids up to $750 per ear per year, with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Value Plus (PPO) plan. For Inpatient Hospital-Acute, there is a $425 copay per admission or stay. Additional days for Inpatient Hospital-Acute have no copay. For Inpatient Hospital Psychiatric, there is a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services, including outpatient hospital services, are covered by the Aetna Medicare Value Plus (PPO) plan with a copay between $0 and $250. Observation services have a $250 copay, while ambulatory surgical center services and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan with prior authorization required. There is no 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 $225 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved and any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Aetna Medicare Value Plus (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Transportation has a $225 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $25 copay. Physician Specialist Services have a copay between $0 and $30. Mental Health and Psychiatric services have a $40 copay. Podiatry Services have a $30 copay, and Routine Foot Care is covered. Other Health Care Professional services have a copay between $0 and $30. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $50. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered under the Aetna Medicare Value Plus (PPO) plan with no copay. Other preventive services like kidney disease education services have a 20% coinsurance. The plan also covers additional services such as health education, wigs for hair loss, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and fitness benefits with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per ear per year, and prescription hearing aids (all types) have no copay, 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 of $0-$30, routine eye exams have no copay, and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $405 per year.
Dental Services See details
Aetna Medicare Value Plus (PPO) covers a variety of dental services, with no copay for 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. Medicare dental services have a $30 copay, 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 by the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Value Plus (PPO) plan covers Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, but does not cover Durable Medical Equipment for use outside the home. Prosthetics/Medical Supplies are covered with no copay and a coinsurance, while Diabetic Equipment is covered with a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests have a copay between $0 and $5, while lab services have no copay. Radiological services are covered, with a copay of up to $230 for diagnostic radiological services, a 20% coinsurance for therapeutic radiological services, and a $25 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance. 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. This plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Value Plus (PPO), but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Aetna Medicare Value Plus (PPO) plan, 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, and Self-Directed Personal Assistance Services are not covered. Over-the-counter (OTC) items have no copay and a maximum plan benefit coverage amount of $105.00 every three months. The plan also covers a meal benefit with no copay and other services such as annual wellness exams and screening mammography, and gFOBT, FIT, all with no copay.
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