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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: Bronx. 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 $26.00. 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 the pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For other tiers, you will pay 24% or 25% coinsurance. 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 a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including primary care, often have no copay. Emergency services and ambulance services are covered with copays. Preventive, hearing, vision, and dental services are included, with no copays for many services. The plan also covers home health services, skilled nursing facilities, and other services, with specific copays and coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $374 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while the plan does not cover Non-Medicare-covered Stay or Upgrades for Inpatient Hospital-Acute, or Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services with the Aetna Medicare Discover Value (PPO) plan includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $395, observation services have a $375 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse each have a copay of $40.
Partial Hospitalization See details
Aetna Medicare Discover Value (PPO) covers partial hospitalization with a $80 copay. 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, with prior authorization required for all ambulance services. Ground and air ambulance services each have a $300 copay, but 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 Value (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $300 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Discover Value (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a copay between $0 and $40. Mental health specialty services and psychiatric services both have a $40 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, 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, while wigs for hair loss related to chemotherapy have no copay but a maximum plan benefit coverage amount of $400. Other covered benefits, such as home safety assessments, are not covered.
Hearing Services See details
Hearing services for the Aetna Medicare Discover Value (PPO) plan include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered with a maximum copay of $1,700, but inner, outer, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Discover Value (PPO) plan covers vision services, including eye exams with a copay ranging from $0 to $40, and eyewear with a combined maximum benefit of $150 per year and no copay. Routine eye exams are covered with no copay for one visit every year, and other eye exam services are covered with no copay and no limit to the number of visits. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with 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, all with no copay. Other services, such as Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. There is a $40 copay for Medicare Dental Services.
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.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Discover Value (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Discover Value (PPO) plan. Durable Medical Equipment (DME) has no copay and a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0-20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $40, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with up to 20% coinsurance, and Outpatient X-Ray Services with a $40 copay. All services require prior authorization.
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 covered by the Aetna Medicare Discover Value (PPO) plan, but the plan does not cover any of the sub-services offered. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by 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 per day.
Other Services See details
Other Services include a meal benefit with no copay, and coverage for annual wellness exams, screening mammograms, gFOBT and FIT with no copay. However, acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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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