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Aetna Medicare Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Value (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central Massachusetts. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value (HMO-POS) 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 (HMO-POS).
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 (HMO-POS), 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.
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 Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 (HMO-POS) plan has a $590 deductible for prescription drugs. Once you meet your deductible, your cost will vary depending on the drug tier and pharmacy you use. For example, you'll pay no copay for preferred generic drugs at preferred and mail-order pharmacies. For standard generic drugs, you pay 24% coinsurance, and for preferred brand drugs, you pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan offers a range of benefits with varying costs. It covers inpatient hospital stays with a copay, outpatient services with copays, and emergency services with a $125 copay. Primary care visits have no copay, while specialist visits and mental health services have a $40 copay. Preventive services, including an annual physical exam, have no copay, with additional benefits like hearing, vision, and dental services. The plan also covers home health services with no copay, medical equipment with coinsurance, and some prescription drugs with copays or coinsurance. Other notable benefits include a quarterly allowance for over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $385 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Value (HMO-POS) plan, including outpatient hospital services with a copay between $0 and $395, observation services with a $320 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value (HMO-POS) plan and requires prior authorization, with a copay of $70.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO-POS) plan. Ground ambulance services have a $285 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Value (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $285 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Value (HMO-POS) plan covers primary care services, including primary care physician services with no copay. Chiropractic services have a $15 copay, and occupational therapy services have a $40 copay. Physician specialist services have a copay between $0 and $40, and physical therapy and speech-language pathology services have a $40 copay. Mental health and psychiatric services, as well as opioid treatment program services, have a $40 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services with the Aetna Medicare Value (HMO-POS) plan include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, 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-$40, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $285 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay, and other 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Value (HMO-POS) plan, and prior authorization is 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 by the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for some services. Diabetic Equipment is covered, with a coinsurance between 0% and 20% for Diabetic Supplies, and no copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
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 $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $170, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value (HMO-POS) plan. Although the plan covers Cardiac Rehabilitation Services, the 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) services are covered by the Aetna Medicare Value (HMO-POS) plan, 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 and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Value (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $60 every three months, and also covers Meal Benefits with no copay. 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.
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