Aetna Medicare Value Plus Plan

If you’re eyeing the Aetna Medicare Value Plus for your health care coverage in 2025, you’re probably asking: What exactly does it offer, and how much does it cost?

Straight to the point – this Medicare Advantage PPO plan for 2024 goes beyond Original Medicare with added prescription drug benefits and wellness programs, all at a cost-effective price point.

This article breaks down the coverage, expenses, and exclusive perks, helping you make an informed decision on your health care.

 

Key Takeaways

  • The Aetna Medicare Value Plus plan is a Medicare Advantage PPO plan for 2024, offering additional benefits over Original Medicare, including prescription drug coverage, wellness programs, and various health screenings.

 

  • The plan focuses on keeping prescription drug expenses manageable with a $250 annual deductible and incorporates coverage for the coverage gap phase, while also offering comprehensive wellness programs and additional services like dental, vision, and hearing benefits.

 

  • Understanding the costs involved with the Aetna Medicare Value Plus plan is crucial; it features a monthly premium of $25.20, varying deductibles based on plan type, and applicants may be eligible for Low-Income Subsidy Assistance to help with prescription drug costs.

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Understanding Aetna Medicare Value Plus

 

Aetna Medicare Value Plus Plan, Understanding Aetna Medicare Value Plus

 

The Aetna Medicare Value Plus plan is a 2024 Medicare Advantage PPO plan that not only provides similar fundamental benefits as Original Medicare but also includes additional advantages.

These additional benefits include prescription drug coverage and wellness programs that are typically not included in Part A or Part B of Original Medicare.

Variations in out-of-pocket expenses, along with the inclusion of other health plan deductibles, make the Aetna Medicare Value Plus plan a comprehensive healthcare solution designed to meet a wide range of healthcare needs. This plan offers a broad range of benefits and coverage, striving to deliver excellent healthcare.

 

Exploring the Coverage Details

 

Aetna Medicare Value Plus Plan, Exploring the Coverage Details

 

Comprehending the specifics of your coverage is fundamental for meeting your healthcare needs. With the Aetna Medicare Value Plus plan, coverage extends beyond mere basic healthcare to include a myriad of medical treatments, screenings, tests, and vaccines.

This plan offers coverage for:

  • Foot exams and treatments

 

  • Diagnostic radiology

 

  • Chemotherapy and other Part B drugs (contingent on the service provider)

 

  • Breast cancer screening

 

  • Colorectal cancer screening

 

  • Yearly flu vaccine

 

  • Skilled nursing facility services

 

This ensures a holistic approach to your healthcare, including chiropractic services and CVS Health.

Managing prescription drug expenses is a significant concern for many, and the Aetna Medicare Value Plus plan addresses this concern head-on.

The plan includes:

  • An annual deductible of $250.00 for prescription drugs

 

  • A $35 copay for Part B insulin drugs

 

  • During the Gap Coverage Phase, a 25% cost-sharing applies to brand-name drugs, ensuring that prescription drug costs remain manageable for plan members

 

  • Out-of-pocket expenses are also a part of the plan when obtaining prescription medications, ensuring transparency, and keeping the members in control of their healthcare expenses.

 

Prescription Drug Coverage Highlights

The Aetna Medicare Value Plus plan offers comprehensive prescription drug coverage. The plan includes a comprehensive list of covered drugs, known as the formulary, ensuring that members have access to the medications they need.

Detailed information about the formulary can be found on the Aetna Medicare website, further enabling members to make informed decisions about their healthcare.

The Aetna Medicare Value Plus plan also considers the coverage gap, or ‘donut hole,’ which is encountered when the drug costs reach $5,030.

Some plans, like SilverScript® Plus, may provide additional coverage during this gap, ensuring that prescription drug costs remain manageable for plan members even during this period.

 

Wellness Programs and Additional Services

Beyond offering comprehensive healthcare and prescription drug coverage, the Aetna Medicare Value Plus plan also includes covered wellness programs and supplementary services. The plan includes a fitness benefit that offers access to tailored workout programs based on your fitness level, promoting healthy living and overall well-being.

By including wellness programs in its offerings, the Aetna Medicare Value Plus plan recognizes the importance of preventive care and holistic health.

Beyond healthcare and wellness, the Aetna Medicare Value Plus plan also provides additional services that contribute to a comprehensive healthcare package.

These services include:

  • Health care services

 

  • Medical supplies

 

  • Dental benefits

 

 

  • Hearing benefits

 

These additional benefits ensure that all aspects of a member’s health are catered to, providing a well-rounded healthcare solution.

Analyzing Health Plan Costs

 

Aetna Medicare Value Plus Plan, Analyzing Health Plan Costs

 

Comprehending the costs linked to your healthcare plan is key for effective financial management. The Aetna Medicare Value Plus plan comes with a monthly premium of $25.20, making it an affordable choice for many.

But it’s not just about the premiums; the plan also includes deductibles for prescription drug coverage. The PPO plan entails an annual drug deductible of $400.00, while the HMO plan involves an annual drug deductible of $300.00.

The Aetna Medicare Value Plus plan also includes co-payment expenses that vary based on the service. Medicare-Covered Podiatry Services, for example, have a co-payment of $20.00.

This is just one example of the costs associated with covered foot care. Comprehending these costs allows members to effectively budget their healthcare expenses and maximize the use of their healthcare plan.

 

Understanding Your Out-of-Pocket Expenses

Out-of-pocket expenses are an integral part of any healthcare plan, and the Aetna Medicare Value Plus plan is no exception.

These expenses may include:

  • Monthly premiums

 

  • Copays

 

  • Coinsurance

 

  • Out-of-network expenses for medical professionals and hospitals

 

  • Annual out-of-pocket limits

 

  • Provisions for dental, vision, hearing, and additional benefits

 

By understanding these costs, members can effectively budget for their healthcare expenses and ensure that they are not caught off guard by unexpected costs.

The Aetna Medicare Value Plus plan includes:

  • An annual drug deductible of $150 for Part D prescription drugs, which forms a component of your total out-of-pocket expenses

 

  • Copays, which are fixed dollar amounts for specific services

 

  • Coinsurance, which is a percentage of the cost of the service that the individual pays after meeting their deductible

 

Comprehending these costs allows members to manage their healthcare expenses more effectively and maximize their healthcare plan’s benefits.

 

Low-Income Subsidy Assistance

The Low-Income Subsidy (LIS) program, also known as Extra Help, is designed to aid individuals with Medicare in covering the costs of prescription drugs.

This program can be advantageous for Aetna Medicare Value Plus plan members by aiding those with limited income and resources in meeting their Medicare prescription drug expenses.

Eligibility for Low-Income Subsidy Assistance in the Aetna Medicare Value Plus plan requires individuals to have an income of up to $1,235 per month and couples with a combined income of up to $1,663.

To apply for this assistance, individuals can:

  • Contact the provided numbers

 

  • Submit an online application through the Social Security Administration website

 

  • Request application support by reaching out to ‘BeneLynk’

 

Eligible members who utilize this assistance can further mitigate their healthcare costs and guarantee access to necessary healthcare.

 

Prescription Drug Plan Phases

 

Aetna Medicare Value Plus Plan, Prescription Drug Plan Phases

 

Understanding the different phases of your prescription drug plan can help you better manage your healthcare expenses. The Aetna Medicare Value Plus plan includes three key phases: the Initial Coverage Phase, the Coverage Gap Phase, and the Catastrophic Coverage Phase.

During the Initial Coverage Phase, individuals will not have to pay any copays for all covered Part D Drugs. However, cost-shares will apply during the initial coverage phase if the plan covers excluded drugs.

The Coverage Gap Phase, also known as the ‘donut hole,’ is encountered when the drug costs reach $5,030. During this phase, individuals will be required to pay a copay or coinsurance for each prescription until they and their plan reach a total of $5,030.

Finally, the Catastrophic Coverage Phase commences when the annual out-of-pocket expenses surpass $6,350. In this phase, the expense for generic drugs is 25% of the total cost, and there is no copayment for brand-name drugs.

Comprehending these phases allows members to plan their prescription drug expenses more effectively and maximize their healthcare plan’s benefits.

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Exclusive Member Benefits

 

Aetna Medicare Value Plus Plan, Exclusive Member Benefits

 

Being a member of the Aetna Medicare Value Plus plan comes with exclusive benefits designed to promote a healthy lifestyle.

These benefits include:

  • Gym memberships

 

  • Fitness programs

 

  • Free gym membership to participating fitness centers

 

  • Online fitness classes

 

  • Health coaching

 

  • Weight-loss programs

 

  • Mental health services at reduced or no cost

 

  • SilverSneakers fitness membership

 

  • A fitness reimbursement benefit of up to $600

 

  • Discounts on other health-related products and services.

 

In addition to health and wellness benefits, the Aetna Medicare Value Plus plan also provides comprehensive dental, vision, and hearing benefits.

These benefits include:

  • Dental coverage for preventive services, such as cleanings and exams, as well as coverage for basic and major services

 

  • Vision coverage for eye exams, glasses, and contact lenses

 

  • Hearing coverage for exams and hearing aids

 

These benefits extend beyond essential services, providing support to members in maintaining their overall health and well-being. The Aetna Medicare Value Plus plan, with its comprehensive benefits, helps members maintain their health and life quality.

 

Navigating Plan Options and Networks

The Aetna Medicare Value Plus plan offers two primary plan options: the HMO plan and the PPO plan.

Each option offers varying levels of coverage and network flexibility, allowing members to choose the option that best fits their healthcare needs and preferences.

Understanding the components of a provider network can help members make the most of their healthcare plan. The provider network in the Aetna Medicare Value Plus Plan comprises a network of healthcare providers, including:

  • doctors

 

  • pharmacies

 

  • dentists

 

  • hospitals

 

These providers have consented to abide by Aetna’s Medicare insurance terms when delivering services to enrollees.

Under the HMO plan, individuals have access to a designated network of healthcare providers, while the PPO plan permits members to seek services from providers within and outside the network, if they accept Medicare and comply with plan terms.

However, seeking services from providers outside of their plan’s network will not provide coverage for the associated expenses, and Medicare will also not assume responsibility for these costs.

Enrollment and Eligibility

 

Aetna Medicare Value Plus Plan, Enrollment and Eligibility

 

Enrollment in the Aetna Medicare Value Plus plan is limited to specific times of the year unless the individual meets the criteria for a special election/enrollment period or is in their Medicare Initial Election Period.

To qualify for the Aetna Medicare Value Plus plan, individuals must be 65 years of age or older, or have a qualifying disability for which they have been receiving Social Security Disability.

Enrollment in the Aetna Medicare Value Plus plan can be done through various methods. Individuals can submit an online application, utilize the plan’s paper enrollment form, or contact Aetna at the provided customer service number.

Furthermore, licensed agents are accessible at the provided number to provide guidance and support throughout the enrollment process, ensuring a smooth enrollment experience for prospective members.

 

Comparing Medicare Advantage Plans

Medicare Advantage plans come in various forms, including:

  • HMO (Health Maintenance Organization)

 

  • PPO (Preferred Provider Organization)

 

  • MSA (Medicare Savings Account)

 

  • PFFS (Private Fee-for-Service)

 

Each plan offers different features and premiums, providing individuals with the flexibility to select based on their specific requirements and financial considerations.

The Aetna Medicare Value Plus plan stands out among these options due to its comprehensive coverage and benefits.

The primary characteristics of this plan encompass:

  • Fundamental costs and coverage

 

  • Healthcare services and medical supplies

 

  • Dental benefits

 

  • Vision benefits

 

  • Hearing benefits

 

These features make the Aetna Medicare Value Plus plan a cost-effective choice for many beneficiaries seeking an Aetna Medicare plan.

With an average cost of only $19 per month, the plan’s affordability makes it a practical choice for those seeking comprehensive healthcare coverage at a reasonable price.

CMS Star Ratings and Member Experience

 

Aetna Medicare Value Plus Plan, CMS Star Ratings and Member Experience

 

The CMS Star Ratings system is a crucial tool for comparing the quality and performance of different Medicare plans.

Every year, the Centers for Medicare & Medicaid Services (CMS) assess plans using this 5-star rating system, providing a reliable benchmark for comparing Medicare plans.

When assigning Star Ratings, CMS considers factors such as:

  • plan quality

 

  • member satisfaction

 

  • Consumer Assessment of Healthcare Providers and Systems (CAHPS)

 

  • Healthcare Effectiveness Data and Information Set (HEDIS)

 

  • Health Outcomes Survey (HOS)

 

Understanding these ratings enables members to make better choices about their healthcare plan, ensuring it aligns with their healthcare needs and expectations.

 

Contacting Aetna for More Information

For comprehensive information about the Aetna Medicare Value Plus plan, it is advisable to reach out to Aetna customer service. Aetna’s customer service representatives are available from 8 AM to 6 PM ET, Monday through Friday, and can be reached at the provided number.

These representatives can provide detailed information about the plan, its benefits, and its coverage, ensuring that members have all the information they need to make informed healthcare decisions.

Aetna’s customer service representatives are ready to assist you with:

  • Answering questions about the plan

 

  • Providing information about the plan’s coverage, costs, and benefits

 

  • Guiding you through the enrollment process

 

They are dedicated to ensuring that you have a smooth and seamless experience while joining the Aetna Medicare Value Plus plan.

Maximizing Your Medicare Advantage Benefits

 

Aetna Medicare Value Plus Plan, Maximizing Your Medicare Advantage Benefits

 

A comprehensive understanding of your Aetna Medicare Advantage Plan and its offerings is necessary to maximize its benefits.

This includes:

  • Understanding your Medicare coverage options

 

  • Inquiring about the relevant aspects of your plan

 

  • Utilizing Aetna’s plan comparison tool for evaluating Advantage plans

 

  • Making prudent financial decisions regarding your coverage

 

By doing so, you can ensure that you are getting the most out of your healthcare plan and that your healthcare needs are being met.

Prescription drug coverage is a key aspect of any healthcare plan, and there are several strategies for maximizing this coverage.

These include utilizing preferred pharmacies if they are offered by your plan and considering filling your prescriptions for a longer-term supply, up to 90 days.

Moreover, the Aetna Medicare Advantage plans include wellness programs like gym memberships and fitness classes without additional costs, along with wellness visits featuring preventive screenings to bolster your health and overall well-being.

By taking advantage of these benefits, you can ensure that you are getting the most out of your Medicare Advantage plan.

Summary

In summary, the Aetna Medicare Value Plus plan offers comprehensive healthcare coverage that caters to a wide range of healthcare needs. With its extensive coverage, additional benefits, and affordable costs, this plan provides an effective solution for those seeking quality healthcare.

Whether you’re navigating plan options, understanding your out-of-pocket expenses, or maximizing your benefits, the Aetna Medicare Value Plus plan is designed to meet your healthcare needs and ensure a healthy aging process.

 

Frequently Asked Questions

 

  What is the difference between Aetna Medicare and Aetna Medicare Advantage?

Aetna Medicare Advantage plans, also known as Part C plans, are offered by private insurance companies such as Aetna® Medicare and can include extra benefits not offered by Original Medicare.

 

  What is an Aetna value plan?

The Aetna Value Plan is a straightforward, flexible plan that allows you to visit any licensed provider and offers reasonable deductibles and copay. It is easy to use and provides both in and out of network coverage.

 

→  What is the payer ID for Aetna Medicare value plan?

You can use electronic payer ID #60054 for the Aetna Medicare value plan.

 

  Is Aetna a PPO or HMO?

Aetna offers an HMO plan called Aetna Open Access, which allows members to visit in-network providers without a referral for covered services.

You can find Aetna network providers using their provider search feature.

 

 What are the eligibility criteria for Aetna Medicare Value Plus?

To be eligible for Aetna Medicare Value Plus, you must be 65 years of age or older, or have a qualifying disability and be receiving Social Security Disability.

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 ZRN Health & Financial Services, LLC, a Texas limited liability company

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Speak with a licensed insurance agent

 1-833-641-4938
TTY 711

Mon-Fri : 8am-9pm EST

Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.