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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 Central Massachusetts. 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 $250.00 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 $9550.00 (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 $9550.00 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 an enhanced alternative drug benefit. The plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Discover (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services and many primary care visits have no copay. Emergency services and ambulance services are covered, but come with copays or coinsurance. Preventive services like annual exams are covered with no copay, and vision and dental services are also included. Hearing exams have a copay, and hearing aids have a maximum copay. The plan also covers home health services and skilled nursing facilities, but with copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, though Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, there is a $395 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, there is a $320 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $395 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Discover (PPO) plan, but requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Discover (PPO) plan. Ground ambulance services have a $285 copay, while 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 by the Aetna Medicare Discover (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $285 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Discover (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $35 copay. Mental health specialty services and psychiatric services have a $35 copay for individual and group sessions. The plan also covers other healthcare professionals with a copay between $0 and $35, and opioid treatment program services with a $35 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Discover (PPO) plan covers preventive services with no copay for services like an annual physical exam, health education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Kidney disease education services have a 20% coinsurance. Additional preventive services, including wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and fitness benefits, are covered with a copay. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a maximum copay of $1700. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
The Aetna Medicare Discover (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay and a combined maximum of $305 per year for both in-network and out-of-network services. Routine eye exams are covered with no copay, and a limit of one per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, and other dental services, including 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 (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic services are covered under Diagnostic and Preventive Dental, and the plan has a maximum benefit of $2,000 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, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Discover (PPO) plan, but prior authorization is required. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Aetna Medicare Discover (PPO) plan. Durable Medical Equipment has a coinsurance of 0% to 20% and requires prior authorization. Prosthetic Devices have a 20% coinsurance. Medical Supplies have a coinsurance of 0% to 20%. Diabetic Supplies have a coinsurance of 0% to 20% and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, and lab services, are covered with a copay of $0-$40 for tests, and no copay for lab services. Diagnostic radiological services have a copay up to $190, and therapeutic radiological services have a coinsurance of 20%, while 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. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Discover (PPO) plan with prior authorization required. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Discover (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $60 every three months. The plan also covers meal benefits and other services like annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other additional services are not covered.
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