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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 IL Northern and Chicago. This plan received an overall rating of 4 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 $17.00. 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 $10100.00 (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 $10100.00 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. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay no copay at preferred pharmacies and through mail order, or a $12 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs all have a 22% or 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers a wide range of benefits with varying cost-sharing. You'll have no copay for primary care visits, preventive services, home health, and many vision and dental services, while specialist visits and outpatient services can range from $0-$365. The plan includes coverage for hospital stays, outpatient services, and emergency care, with copays applying to some services like inpatient stays and ambulance services. You'll also have coverage for hearing, vision, and dental, as well as medical equipment and home infusion.
Inpatient Hospital See details
The Aetna Medicare Value Plus (PPO) plan covers Inpatient Hospital services, including acute and psychiatric care, with prior authorization required. For Inpatient Hospital-Acute, there is a $365 copay for days 1-8, and no copay for days 9-90. For Inpatient Hospital Psychiatric, there is a $325 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while the non-Medicare-covered stay and upgrades are not covered. Additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered under the Aetna Medicare Value Plus (PPO) plan, including outpatient hospital services with a copay between $0 and $365, observation services with a $365 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $75 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. You will have a $75 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (PPO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Value Plus (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a $275 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Value Plus (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $30 copay. Specialist visits have a $30 copay, and physical therapy and speech-language pathology services have a $30 copay. Mental health, psychiatric services, and opioid treatment program services are covered with a copay of $30. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Value Plus (PPO) plan covers preventive services, including annual physical exams with no copay. Additional preventive services include Health Education, Wigs for Hair Loss Related to Chemotherapy, 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 such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear per year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Under the Aetna Medicare Value Plus (PPO) plan, vision services are covered, including eye exams with a copay of $0-$30 and eyewear with no copay and a combined maximum benefit of $150 per year. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
Dental Services are covered, with a $30 copay for Medicare Dental Services and no copay for Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning). Other services like Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with coinsurance between 20% and 50%, with the exception of Prosthodontics (removable) and Prosthodontics (fixed), which have a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Value Plus (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 0-20% coinsurance and requires authorization, Prosthetics/Medical Supplies with no copay and an unspecified coinsurance, and Diabetic Equipment with varying copays and coinsurance, including 0-20% coinsurance 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 include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $75, lab services with no copay, diagnostic radiological services with a copay up to $250, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with a $10 copay. Radiological services require prior authorization.
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. 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 Plus (PPO) plan with prior authorization required. For days 1-20, the copay is $10, and for days 21-100, the copay is $214, while additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan's "Other Services" benefit covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, and other services are not covered. OTC items have a maximum benefit of $30 every three months.
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