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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 Central Upstate NY 1. 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 $33.00. 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 a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay when using a preferred pharmacy or mail order, but have a $12 copay at a standard pharmacy. For standard generic drugs, preferred brands, and non-preferred drugs, you pay 24% or 25% coinsurance, depending on the drug tier. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Discover Value (PPO) plan offers comprehensive coverage with a variety of benefits. You'll have no copays for primary care, outpatient blood services, preventive services, and home health services. The plan also covers dental, vision, and hearing services, with varying copays and coverage limits. For hospital stays, you'll pay a $300 copay for inpatient acute and psychiatric care for the first six days, with no copay for the remaining days. Emergency services have a $110 copay, and ambulance services have a $300 copay. Additionally, the plan covers medical equipment, diagnostic services, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-6, and no copay for days 7-90; Additional Days for Inpatient Hospital-Acute are covered with no copay. Inpatient Hospital Psychiatric has a $300 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered Stay 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 a copay between $0 and $300, observation services with a $300 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Discover Value (PPO) plan, with a copay of $80.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Discover Value (PPO) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance, while Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Aetna Medicare Discover Value (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Primary care physician services have no copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $35 copay, while specialist services have a copay between $0 and $30. Mental health specialty services, including individual and group sessions, have a $40 copay. Other health care professional services have a copay between $0 and $30. Psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. Kidney disease education services have a 20% coinsurance, and wigs for hair loss related to chemotherapy are covered with no copay, up to $400 per year. Other services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids (all types) have a maximum copay of $1700, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $30, and eyewear including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades with no copay. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental services include a $30 copay for Medicare dental services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, fixed, and oral and maxillofacial surgery. This plan has a $1,500 annual maximum for dental services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Discover Value (PPO) plan, but require prior authorization. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a coinsurance of 0-20%, while Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance; Medical Supplies and Diabetic Supplies have a coinsurance of 0-20%. 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 $30, and lab services with no copay. Therapeutic radiological services have a coinsurance of at most 20%, diagnostic radiological services have a copay of at most $225, and outpatient X-ray services have a $30 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 technically covered, but not covered in practice. 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 under the Aetna Medicare Discover Value (PPO) plan, but require prior authorization. For days 1-20, there is no copay, 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 includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and also includes annual wellness exams, screening mammography, and gFOBT/FIT tests with no copay. Acupuncture, 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, 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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