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Aetna Medicare Advantra Credit Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Credit Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra Credit Value (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Credit Value (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Credit Value (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 Advantra Credit Value (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 Advantra Credit Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $53.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $950.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $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:
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Drug Coverage
The Aetna Medicare Advantra Credit Value (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, with a $12 copay at standard pharmacies. Standard generic drugs have 24% coinsurance, while preferred brand and non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Advantra Credit Value (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. You'll have access to primary care for a $5 copay, and many preventive services are covered with no copay. This plan also covers hearing, vision, and dental services, with copays for exams and other services. Additional benefits include home health services with no copay, ambulance and transportation services with copays, and coverage for durable medical equipment, and other services, such as an over-the-counter allowance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care, with a copay of $375 for days 1-7 and no copay for days 8-90 for acute care, and a copay of $350 for days 1-5 and no copay for days 6-90 for psychiatric care. Additional days for Inpatient Hospital-Acute are covered, and non-Medicare-covered stays and upgrades for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $360, observation services with a $360 copay, ambulatory surgical center services with no copay, individual and group sessions for outpatient substance abuse with a $45 copay, and outpatient blood services with no copay. This plan also waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Credit Value (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Credit Value (PPO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location have no copay, and any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Advantra Credit Value (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Aetna Medicare Advantra Credit Value (PPO) plan covers primary care physician services with a $5 copay. Chiropractic services have a $15 copay, and occupational therapy services have a $35 copay. Physician specialist services have a $50 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a 20% coinsurance with a $0-$50 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include annual physical exams with no copay. Additional preventive services such as health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance.
Hearing Services See details
Hearing exams are covered under the Aetna Medicare Advantra Credit Value (PPO) plan with a $50 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $500 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
The Aetna Medicare Advantra Credit Value (PPO) plan covers vision services, including eye exams with a copay between $0 and $50, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage of $175 per year for both in and out-of-network services.
Dental Services See details
The Aetna Medicare Advantra Credit Value (PPO) plan covers Medicare dental services with a $50 copay, and other dental services, with a maximum benefit of $1,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Credit Value (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Advantra Credit Value (PPO) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. For durable medical equipment, there is no copay, and the coinsurance ranges from 0% to 20%; however, durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, while medical supplies have a 0% to 20% coinsurance. Diabetic supplies have a 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $350, Therapeutic Radiological Services have a copay up to $80, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Credit Value (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Advantra Credit Value (PPO) plan, but specific services such as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. While the plan mentions a copay, the specific amount is not listed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Advantra Credit Value (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage of $45 every three months. This plan also covers meal benefits and other services, including annual wellness exams and screening mammography, and gFOBT, FIT, with no copay. However, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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