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Aetna Medicare Discover Value Plan (PPO)

4 out of 5 stars* for plan year 2024
$28.00 Monthly Premium

Aetna Medicare Discover Value Plan (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.

Plan ID: H5521-340-000

$28.00 Monthly Premium

New York Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about New York Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage Details
Monthly plan premium$28.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$250.00
Out-of-pocket maximum$8,500.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$8,000.00
Primary care doctor visit$0 in-network | $45 out-of-network
Specialty doctor visit$30 in-network | $50 out-of-network
Inpatient hospital care$325 per day, days 1-6; $0 per day, days 7-90 in-network | $500 per day, days 1-20; $0 per day, days 21-90 out-of-network
Urgent care
Urgent Care:
Copayment for Urgent Care $50.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $100.00
Emergency room visit$100 If you are admitted to the hospital within 0 hours your cost share may be waived, for more information see the Evidence of Coverage
Ambulance transportation$300 in-network | $300 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Discover Value Plan (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Discover Value Plan (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $15.00
Prior Authorization Required for Chiropractic Services
Diabetes supplies, training, nutrition therapy and monitoring0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.
Durable medical equipment (DME)0% - 20% for each Medicare-covered durable medical equipment item | 0% for continuous glucose meters | 20% for all other Medicare-covered DME items | 40% out-of-network
Diagnostic tests, lab and radiology services, and X-raysLab Services: Lab Services: $0 in-network| 40% out-of-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $30 in-network| 40% out-of-network, for more information see Evidence of Coverage
Imaging: Xray: $30 in-network | CT Scans: $175 for CT/CAT scans in-network; $225 for all other complex imaging in-network | Diagnostic Radiology other than CT Scans: $175 for CT/CAT scans in-network; $225 for all other complex imaging in-network | Diagnostic Radiology Mammogram: $0 in-network | 40% out-of-network, for more information see Evidence of Coverage
Home health care$0 in-network | 40% out-of-network
Mental health inpatient care
Out-of-Network:
Coinsurance for Psychiatric Hospital Services per Stay 40%
Mental health outpatient careMental Health - Group Sessions: $40 in-network| Mental Health - Individual Sessions: $40 in-network| 40% out-of-network, for more information see Evidence of Coverage |Psychiatric Services - Group Sessions: $40 in-network| Psychiatric Services - Individual Sessions: $40 in-network| 40% out-of-network, for more information see Evidence of Coverage
Outpatient services/surgeryAmbulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy | $250 All other in network ASC services | 40% out-of-network, for more information see Evidence of Coverage
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $40.00
Copayment for Medicare-covered Group Sessions $40.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter itemsIn Network: |Over-the-counter (OTC) items:|$105 quarterly amount (allowance) to purchase approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers and more. Approved items can be purchased online, in store, or by phone. |Be sure to use the full benefit amount quarterly, because any unused amount will not rollover.|Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit, for more information see Evidence of Coverage
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $30.00
Skilled Nursing Facility (SNF) care$0 per day, days 1-20; $203 per day, days 21-100 in-network| 40% per stay out-of-network, for more information see Evidence of Coverage

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental careIn Network Dental Coverage|For covered services: ADA recognized dental services are covered excluding only cosmetic services, those considered medical in nature, and administrative changes.|Preventive dental services: |Oral exams: $0 copay |Cleanings: $0 copay |Fluoride treatment: $0 copay |Bitewing x-rays: $0 copay |Comprehensive dental services:|Non-routine services: $0 copay |Diagnostic services: $0 copay |Restorative services: $0 copay |Endodontics: $0 copay |Periodontics: $0 copay |Extractions: $0 copay |Prosthodontics and maxillofacial services: $0 copay |Out Of Network Dental Coverage|Preventive dental services:| $0 copay |Comprehensive dental services:| $0 copay |$1,750 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage.

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Vision benefitsIn-Network:|Eye Exams:|Copayment for Medicare Covered Benefits $0-$30|Copayment for Routine Eye Exams $0 |(Maximum one exam every year)|Eyewear:|Copayment for Medicare Covered Benefits $0|Copayment for Contacts $0|Copayment for Eyeglasses $0|Copayment for Eyeglass Frames $0|Copayment for Eyeglass Lenses $0|Copayment for Upgrades $0|Out-of-Network:|Eye Exams: |Copayment for Medicare-Covered Benefits $50|Copayment for Routine Eye Exams $50|Eyewear:|Coinsurance for Medicare-Covered Benefits 40%|Copayment for Non-Medicare covered Benefits $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $200 every year. See the Evidence of Coverage

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Hearing benefitsIn-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $30|Copayment for Routine hearing Exams $0|(Maximum one exam every year)|Copayment for Fitting/Evaluation for Hearing Aid $0|(Maximum one hearing aid fitting/evaluation every year)|Hearing Aids:|Copayment for Hearing Aids $0|(Maximum two hearing aids every year) |Out-of-Network:|Copayment for Medicare Covered Hearing Exams $50|Copayment for Non-Medicare Covered Hearing Exams $50 |Member must purchase hearing aids through NationsHearing|$1,250 per ear every year, for more information see the Evidence of Coverage

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Preventive services and health/wellness education programs$0 copay for all preventive services covered under Original Medicare at zero cost sharing

Prescription Drug Costs and Coverage

The Aetna Medicare Discover Value Plan (PPO) offers prescription drug coverage, with an annual drug deductible of $250.00 (excludes Tiers 1 and 2)

Coverage
Cost
Coverage & Cost
Annual drug deductible$250.00 (excludes Tiers 1 and 2)
Tier 1
  • Preferred retail $0.00
  • Standard retail $5.00
  • Preferred mail order $0.00
  • Standard mail order $5.00
  • Tier 2
  • Preferred retail $0.00
  • Standard retail $10.00
  • Preferred mail order $0.00
  • Standard mail order $10.00
  • Annual drug deductible$250.00 (excludes Tiers 1 and 2)
    Tier 1
  • Preferred retail $0.00
  • Standard retail $10.00
  • Preferred mail order $0.00
  • Standard mail order $10.00
  • Tier 2
  • Preferred retail $0.00
  • Standard retail $20.00
  • Preferred mail order $0.00
  • Standard mail order $20.00
  • Annual drug deductible$250.00 (excludes Tiers 1 and 2)
    Tier 1
  • Preferred retail $0.00
  • Standard retail $15.00
  • Preferred mail order $0.00
  • Standard mail order $15.00
  • Tier 2
  • Preferred retail $0.00
  • Standard retail $30.00
  • Preferred mail order $0.00
  • Standard mail order $30.00
  • When reviewing New York Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

    You may be able to find plans in your part of New York that offer similar benefits at similar or lower prices than the plan above. Call 1-877-890-1409 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

    Plan Documents

    Links to plan documents

    New York Counties Served

    We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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