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Aetna Medicare Discover Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Discover Value Plus (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 Discover Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Discover Value Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Eastern/Central Missouri. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Discover Value Plus (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 Discover Value Plus (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 Discover Value Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.80. 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 $3300.00 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 Discover Value Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a $590 deductible. In the initial coverage phase, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you will have no copay for preferred generic drugs at a preferred pharmacy or preferred mail, while standard generic drugs have a 24% coinsurance. After 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 Discover Value Plus (HMO-POS) plan offers a range of benefits with varying cost-sharing. Many services have no copay, including primary care visits, eye exams, and dental services. However, there are copays for services like inpatient hospital stays, outpatient services, specialist visits, and hearing exams. The plan includes coverage for emergency services, ambulance services, and home health services, with specific copays or coinsurance amounts. Additionally, it provides benefits for prescription hearing aids, eyewear, and medical equipment, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $335 copay for days 1-6 and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $310 copay for days 1-6 and no copay for days 7-90. Additional days and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $275, observation services have a $335 copay, and ambulatory surgical center services have no copay. Individual sessions for outpatient substance abuse have a $40 copay, while group sessions have a $30 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Discover Value Plus (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $85.
Ambulance and Transportation Services See details
The Aetna Medicare Discover Value Plus (HMO-POS) plan covers ambulance services, with a $290 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Discover Value Plus (HMO-POS) plan, including Emergency Services, Urgently Needed Services, and Worldwide Emergency Services. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay for routine care, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $0-$30 copay, Mental Health Specialty Services with a $40 copay for individual sessions and a $30 copay for group sessions, Podiatry Services with a $30 copay for Medicare-covered services and routine foot care, Other Health Care Professional services with a $0-$30 copay, Psychiatric Services with a $40 copay for individual sessions and a $30 copay for group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, Additional Telehealth Benefits with a 20% coinsurance and a $0-$40 copay, and Opioid Treatment Program Services with a $40 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services for which you may have to pay a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, have no copay.
Hearing Services See details
Hearing exams are covered with a $40 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids are covered with a plan-specified amount per period with a maximum of $1500.00. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams, including 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, also have no copay, with a combined maximum of $300 every year.
Dental Services See details
The Aetna Medicare Discover Value Plus (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Medicare Dental Services require a $40 copay. The plan does not cover maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Discover Value Plus (HMO-POS) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Discover Value Plus (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a $0-$40 copay for Diagnostic Procedures/Tests, and a $0 copay for Lab Services. Diagnostic Radiological Services have a copay of at most $140, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Discover Value Plus (HMO-POS) plan with no copay and no coinsurance. However, 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 Discover Value Plus (HMO-POS) 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) benefits are covered by the Aetna Medicare Discover Value Plus (HMO-POS) plan with prior authorization required. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits with no copay, with OTC items having a maximum benefit of $60 every three months. 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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