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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 Western NY. 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 $25.00. 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 $450.00 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 $9500.00 (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 $9500.00 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 $450 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will have no copay for preferred generic drugs at preferred pharmacies or preferred mail order. However, you will pay 22% coinsurance for standard generic drugs, 25% coinsurance for preferred brand drugs, and 27% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Discover Value (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. It includes coverage for emergency services, primary care, preventive services, and home health services, often with no copay. This plan also provides benefits for hearing, vision, and dental services, with specific copays and annual maximums for dental. Additional benefits include coverage for ambulance services, partial hospitalization, and various therapies. The plan also offers coverage for medical equipment, diagnostic services, and skilled nursing facilities. Furthermore, it includes an over-the-counter allowance, a meal benefit, and other services like annual wellness exams.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-6, and no copay for days 7-90; and for Inpatient Hospital Psychiatric, you 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, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. 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 for Outpatient Hospital Services, and a $300 copay for Observation Services. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $25 copay for both individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by the Aetna Medicare Discover Value (PPO) plan. You will pay an $80 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Discover Value (PPO) plan, with a $300 copay for both ground and air ambulance services and no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. For Emergency Services and Worldwide Emergency Coverage, the copay is $110, and for Urgently Needed Services, the copay is $45; all three have no coinsurance. Worldwide Emergency Transportation has a $300 copay and no coinsurance.
Primary Care See details
The Aetna Medicare Discover Value (PPO) plan covers primary care physician services with no copay and chiropractic services with a $15 copay. This plan also covers occupational therapy services with a $25 copay, physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $25 copay. Mental health and psychiatric services have a $25 copay for individual and group sessions, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by Aetna Medicare Discover Value (PPO), including an annual physical exam with no copay, as well as Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing Services includes hearing exams with a $25 copay and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are partially covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Aetna Medicare Discover Value (PPO) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with no copay. Routine eye exams are limited to one per year with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay, up to a combined maximum of $300 per year.
Dental Services See details
Dental services with the Aetna Medicare Discover Value (PPO) plan include coverage for Medicare Dental Services with a $25 copay, and other services like oral exams, dental x-rays, and more with no copay. The plan has a maximum benefit of $2,000 per year for both in and out-of-network services, and does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered under the Aetna Medicare Discover Value (PPO) plan. 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, and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a coinsurance between 0% and 20%, while Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by this plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $200, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $25 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 the plan does not cover any of the sub-services, including 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. There is a copay for services, but the specific amount is not mentioned.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Discover Value (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Discover Value (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $75 every three months. The plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. The plan also covers a meal benefit with no copay. Other services such as annual wellness exams, screening mammography, gFOBT, and FIT are covered with no copay.
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