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Aetna Medicare Discover Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Discover Value (PPO). 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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Discover Value (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Metro Area: Brooklyn, NYC, Queens. 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 (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 Discover Value (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 Discover Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. 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 $14000.00 (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 $14000.00 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 Discover Value (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. In the initial coverage phase, after the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. Standard generic drugs have 24% coinsurance.
Additional Benefits
The Aetna Medicare Discover Value (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for primary care physician services, annual physical exams, and preventive services like health education and screenings, and a $0 copay for many vision and dental services. The plan also covers inpatient hospital stays with copays, outpatient services with copays, and emergency services with copays. Additional benefits include coverage for hearing and vision services, home health services, and diagnostic services, as well as prescription hearing aids with a maximum copay.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, require prior authorization. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $339 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $395, and observation services, with a copay of $395. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Discover Value (PPO) plan with a $80 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a $300 copay, and there is no 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 by the Aetna Medicare Discover Value (PPO) plan. Emergency Services has a $110 copay and no coinsurance, Urgently Needed Services has a $45 copay and no coinsurance, and Worldwide Emergency Services has a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation, and no coinsurance.
Primary Care See details
Primary Care services include a $0 copay for Primary Care Physician Services, a $15 copay for Chiropractic Services, and a $35 copay for Occupational Therapy Services. This plan also covers Physician Specialist Services with a copay between $0 and $40, and Physical Therapy and Speech-Language Pathology Services with a $35 copay. Mental Health and Psychiatric Services each have a $40 copay for individual or group sessions, and Opioid Treatment Program Services have a copay between $40. Additional Telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Other Health Care Professional services have a copay between $0 and $40. However, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Discover Value (PPO) plan covers preventive services, including an annual physical exam with no copay, and additional services like health education, nutritional/dietary benefits, and wigs for hair loss due to chemotherapy, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing exams are covered by the Aetna Medicare Discover Value (PPO) plan with a $40 copay, as are routine hearing exams and fitting/evaluation for hearing aids, both with no copay. Prescription hearing aids are covered, with a maximum copay of $1700, while 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, eyeglass lenses, eyeglass frames, and upgrades, have a combined maximum benefit of $200 per year and no copay.
Dental Services See details
The Aetna Medicare Discover Value (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay, but there is a $40 copay for Medicare dental services. This plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 Discover Value (PPO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Aetna Medicare Discover Value (PPO) plan. Durable Medical Equipment has no copay and a coinsurance of 0-20%, with Durable Medical Equipment for use outside the home not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Medical Supplies and Diabetic Supplies have a coinsurance of 0-20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $40, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Discover Value (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 Discover Value (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 Discover Value (PPO) plan, but prior authorization is required. There is no copay for days 1-20, but there is a $205 copay for days 21-100; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Discover Value (PPO) plan covers meal benefits, annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, over-the-counter items, Dual Eligible SNPs, 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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