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Verified against CMS.gov · on April 2026 Plan ID: H3288-019 Cross-check on Medicare.gov →

Aetna Medicare Value Plus (PPO)

Plan Year 2026
$15.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
1,055 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 HYDROCODONE BITARTRATE AND ACETAMINOPHEN Brand Tier 3 0.2% coinsurance Details
2 JAYPIRCA pirtobrutinib Brand Tier 5 0.3% coinsurance Details
3 TicoVac Tick-Borne Encephalitis Vaccine Brand Tier 1 $0.00 Details
4 ISENTRESS RALTEGRAVIR Brand Tier 5 0.3% coinsurance Details
5 Loxapine Brand Tier 2 $0.00 Details
6 Erlotinib Brand Tier 3 0.2% coinsurance Details
7 ENTRESTO Sacubitril and Valsartan Brand Tier 3 0.2% coinsurance Details
8 FARXIGA DAPAGLIFLOZIN Brand Tier 3 0.2% coinsurance Details
9 Mifepristone Brand Tier 5 0.3% coinsurance Details
10 RotaTeq Rotavirus Vaccine, Live, Oral, Pentavalent Brand Tier 1 $0.00 Details
11 Gilotrif afatinib Brand Tier 5 0.3% coinsurance Details
12 Buspirone Hydrochloride Brand Tier 1 $0.00 Details
13 Sodium Chloride Brand Tier 4 0.3% coinsurance Details
14 Potassium Chloride potassium chloride Brand Tier 2 $0.00 Details
15 BOSULIF Bosutinib Brand Tier 5 0.3% coinsurance Details
16 Buspirone Hydrochloride Brand Tier 1 $0.00 Details
17 ETHOSUXIMIDE Brand Tier 4 0.3% coinsurance Details
18 RYDAPT Brand Tier 5 0.3% coinsurance Details
19 Talzenna talazoparib Brand Tier 5 0.3% coinsurance Details
20 Dexamethasone Brand Tier 4 0.3% coinsurance Details

Showing 20 of 1,055 covered drugs.

Compare this plan against others for your medications Enter your drugs and ZIP to see personalized out-of-pocket costs.
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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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