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Aetna Medicare Discover (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Discover (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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Discover (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Connecticut. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Discover (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 (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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 (PPO) plan has a $450 deductible for prescription drugs. After the deductible is met, you will pay the following costs for drugs based on the tier and pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order. Standard pharmacies and standard mail order have a $12 copay. Standard generic drugs have 22% coinsurance, preferred brand drugs have 25% coinsurance, and non-preferred drugs have 27% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Discover (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays depending on the length of stay, while outpatient services have copays from $0-$395. Emergency, urgent, and worldwide emergency services have copays ranging from $40 to $310. The plan includes no copays for primary care physician services, routine hearing exams, and many vision and dental services. You'll also find no copays for home health services, over-the-counter items, and preventive services like annual physical exams and screening mammography. However, some services, like ambulance, dialysis, and skilled nursing facilities, have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $385 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $0-$395, and observation services with a copay of $395. Ambulatory Surgical Center (ASC) Services have no copay, Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Discover (PPO) plan, with a $70 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Discover (PPO) plan. Ground ambulance services have a $310 copay, and air ambulance services have a 20% 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 under the Aetna Medicare Discover (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $310 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $15 copay for Chiropractic Services (excluding routine care), a $40 copay for Occupational Therapy Services, and a copay between $0 and $40 for Physician Specialist Services. Mental Health Specialty Services, including individual and group sessions, have a $40 copay. Other Health Care Professional services have a copay between $0 and $40, and Psychiatric Services, including individual and group sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $40 and 20% coinsurance, and Opioid Treatment Program Services have a $40 copay. Routine care is not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with various copays, including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies. Kidney Disease Education Services have a 20% coinsurance, and other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay of up to $1,700. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $40, and eyewear with no copay. Routine eye exams have no copay, and Other Eye Exam Services and Contact Lenses, Eyeglasses (lenses and frames), Eyeglass lenses, Eyeglass frames, and Upgrades all have no copay. Eyewear has a combined maximum plan benefit coverage of $240 every year.
Dental Services See details
Dental Services are covered by the Aetna Medicare Discover (PPO) plan, with a $40 copay for Medicare Dental Services and a $1,000 maximum benefit per year. 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 have no copay. However, 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 under the Aetna Medicare Discover (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Discover (PPO) plan. Durable Medical Equipment (DME) has a coinsurance of 0-20%, and requires authorization. Prosthetic devices have a 20% coinsurance, and medical supplies have a coinsurance of 0-20%. Diabetic equipment is covered, with coinsurance and copay amounts varying by service, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Discover (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $40, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $175, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Discover (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 (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 (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Discover (PPO) plan's "Other Services" benefit covers over-the-counter items with no copay, and a maximum benefit of $50 every three months. Other covered services include meal benefits, annual wellness exams, screening mammography, and gFOBT/FIT, all with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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