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Aetna Medicare Eagle (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Eagle (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Eagle (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in South Dakota. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Eagle (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Eagle (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 Eagle (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. Additionally, this plan comes with a Part B Premium reduction of $70.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (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 $10000.00 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
Prescription drugs are not covered by Aetna Medicare Eagle (PPO).
Additional Benefits
The Aetna Medicare Eagle (PPO) plan offers robust coverage with no copays or coinsurance for primary care visits, routine preventive care, and home health services. Specialist visits and outpatient hospital services feature low copays ranging from $0 to $40, while inpatient hospital stays require daily copays for the first several days with no coinsurance. Emergency care is covered with a $130 copay, and urgent care requires a $50 copay, both featuring no coinsurance. Beneficiaries also enjoy valuable supplemental benefits, including routine hearing and vision exams with no copays, alongside generous allowances for eyewear and hearing aids. Dental care is covered up to a $2,000 annual limit, with no copays for most covered preventive and comprehensive services. Additionally, the plan provides a $45 quarterly allowance for over-the-counter items and no copays for medical equipment or home infusion services.
Inpatient Hospital See details
Inpatient Hospital care under Aetna Medicare Eagle (PPO) is partially covered with no coinsurance, requiring a $325 daily copay for days 1 to 6 of an acute stay and a $370 daily copay for days 1 to 5 of a psychiatric stay, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Eagle (PPO) are covered with no coinsurance, including ambulatory surgical center and blood services which also require no copay. Outpatient hospital services have no coinsurance and a copay of $0 to $325 ($325 per stay for observation), while outpatient substance abuse sessions feature no coinsurance and a $40 copay.
Partial Hospitalization See details
Aetna Medicare Eagle (PPO) covers partial hospitalization services with no coinsurance, though prior authorization is required. Depending on the specific service, you will pay a copay of either $55.00 or $145.00.
Ambulance and Transportation Services See details
Aetna Medicare Eagle (PPO) covers ambulance services with prior authorization, requiring a $320 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Non-emergency transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Eagle (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours, and urgent care with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays of $130 for emergency or urgent care and $320 for emergency transportation.
Primary Care See details
Aetna Medicare Eagle (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Therapy, mental health, and psychiatric services generally require a $40 copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Eagle (PPO) preventive services are generally covered with no copay and no coinsurance, including annual physical exams, fitness benefits, and glaucoma screenings. Kidney disease education is covered with no copay but requires a 20% coinsurance, while specific supplemental services such as in-home safety assessments, weight management programs, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle (PPO), featuring no deductible, no copay, and no coinsurance for routine exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to a $1,250 maximum per ear annually, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Aetna Medicare Eagle (PPO) vision services are covered with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. The plan provides up to a $50 annual maximum for routine eye exams and a $200 yearly combined allowance for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Eagle (PPO) with a $2,000 annual maximum benefit for both in- and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Eagle (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and prescription drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Eagle (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic supplies, with no copay. Prior authorization is required, and coinsurance ranges from no coinsurance up to 20% depending on the specific equipment or supply.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $20 copay for diagnostic tests. Radiological services require prior authorization, with outpatient X-rays carrying a $10 copay plus coinsurance, and therapeutic services requiring at least 20% coinsurance.
Home Health Services See details
Aetna Medicare Eagle (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Eagle (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Eagle (PPO) provides partial coverage for other services with no copay and no coinsurance for meals, annual wellness exams, mammography screenings, and up to $45 quarterly for over-the-counter items. Acupuncture is not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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