A non-government entity
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 2025 to people living in Central Pennsylvania. 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 $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 $11300.00 (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 $11300.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Value Care (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service for up to a three-month supply. Standard pharmacies and mail-order options charge low copays starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Higher-tier medications require coinsurance rather than flat copays across all pharmacy and mail-order networks. Tier 3 preferred brand drugs carry a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Specialty medications under Tier 5 are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers robust coverage with no copay or coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a $10 to $30 copay, while inpatient hospital stays incur a $550 copay per stay with no coinsurance. Emergency care is accessible with a $115 copay, and urgent care visits require a $40 copay, both featuring no deductible or coinsurance. For routine care, the plan features no copay and no coinsurance for preventive dental, annual eye exams, and routine hearing exams, which also includes a $500 annual hearing aid allowance per ear. Supplemental benefits are further enhanced by a $200 annual eyewear allowance and a $30 quarterly over-the-counter reimbursement, both with no copay or coinsurance. Comprehensive dental services are also available with coinsurance ranging from 20% to 50% up to a $1,250 yearly limit.
Inpatient Hospital See details
Aetna Medicare Value Care (PPO) covers inpatient acute hospital stays with a $550 copay per stay and psychiatric stays with a $350 daily copay for days 1 through 5 and no copay for days 6 through 90, both featuring no coinsurance. Unlimited additional acute days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Aetna Medicare Value Care (PPO) feature no coinsurance across all categories. Under this plan, you will pay no copay for ambulatory surgical center and outpatient blood services, a $35 copay for outpatient substance abuse sessions, a $300 copay per stay for observation services, and a $0 to $300 copay for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Care (PPO) with no coinsurance, though prior authorization is required. Depending on the service, you will pay either no copay or a $110 copay.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (PPO) covers ambulance services with prior authorization, requiring a $250 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Value Care (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both featuring no coinsurance and no deductible. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $115 to $250.
Primary Care See details
Primary care benefits under Aetna Medicare Value Care (PPO) feature no copay and no coinsurance for primary care physician visits, and a $10 to $30 copay with no coinsurance for specialist services. Physical, occupational, and speech therapies require a $30 copay and no coinsurance, while chiropractic services are partially covered with routine care costing a $15 copay and no coinsurance, and other chiropractic services not covered.
Preventive Services See details
Aetna Medicare Value Care (PPO) partially covers preventive services with no copay and no coinsurance for annual physicals, fitness benefits, and screenings, though kidney disease education requires a 20% coinsurance and no copay. Non-covered services include in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Aetna Medicare Value Care (PPO) offers partially covered hearing services with no deductible and no coinsurance. Medicare-covered exams have a $30 copay, while routine exams, fitting evaluations, and prescription hearing aids have no copay with a $500 annual limit per ear. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aid types, are not covered.
Vision Services See details
Aetna Medicare Value Care (PPO) covers vision services with no coinsurance, offering eye exams with a $0 to $30 copay and a $50 annual maximum. Eyewear, including contact lenses and eyeglasses, is covered with no copay, no coinsurance, and a combined annual limit of $200.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Care (PPO), offering preventive care like exams, cleanings, and x-rays with no copay and no coinsurance, while Medicare-covered dental requires a $30 copay and no coinsurance. Comprehensive benefits like restorative and endodontic services are covered with no copay and 20% to 50% coinsurance up to a $1,250 yearly limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Care (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin requires a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Care (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers durable medical equipment, prosthetics, and diabetic supplies with no copay, though prior authorization is required. Coinsurance ranges from no coinsurance up to 20% for medical and diabetic supplies, while prosthetic devices and diabetic therapeutic shoes require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Care (PPO), with no copay and no coinsurance for diagnostic tests, lab work, and diagnostic radiology. Outpatient X-rays require a $25 copay, therapeutic radiological services have a 20% coinsurance, and prior authorization is required for these services.
Home Health Services See details
Aetna Medicare Value Care (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Value Care (PPO) with no coinsurance and no copay; however, only some services are covered, and standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Care (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other Services are partially covered under Aetna Medicare Value Care (PPO), as acupuncture is not covered. Covered benefits such as chronic illness meals, annual wellness exams, select colorectal screenings, and a $30 quarterly over-the-counter reimbursement are all offered with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved