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Aetna Medicare Advantra Eagle (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Eagle (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra Eagle (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Eagle (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Eagle (HMO) 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 Advantra Eagle (HMO).
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 Advantra Eagle (HMO), 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 $105.00. 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 Maximum Out-Of-Pocket cost of $6900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Advantra Eagle (HMO).
Additional Benefits
The Aetna Medicare Advantra Eagle (HMO) plan offers a range of benefits with varying costs. You'll find no copay for primary care, preventive services, dental services, home health services, and many outpatient services. However, you may have copays for inpatient hospital stays, emergency services, specialist visits, hearing exams, and other services. This plan includes coverage for hearing, vision, and dental services. You'll pay a copay for some services, with some having no copay. The plan also covers ambulance and transportation services with a copay or coinsurance, and offers coverage for medical equipment and home infusion services, with some services requiring a coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered. For Inpatient Hospital-Acute, you pay a copay of $295 for days 1-7, and no copay for days 8-90. Inpatient Hospital Psychiatric has a copay of $176 for days 1-9, and no copay for days 10-90.
Outpatient Services See details
Outpatient Services include 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 $250, observation services have a $250 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $5.
Partial Hospitalization See details
Aetna Medicare Advantra Eagle (HMO) covers partial hospitalization with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Eagle (HMO) plan. Ground ambulance services have a $250 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 Advantra Eagle (HMO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
Aetna Medicare Advantra Eagle (HMO) covers Primary Care Physician Services with no copay. Chiropractic Services, including routine care, have a $15 copay, with a limit of 12 visits per year. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have a $15 copay, while Physician Specialist Services have a copay between $0 and $15. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $5 copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $15. Podiatry services and Additional Telehealth Benefits have a $15 copay, and a 20% coinsurance.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services, some of which have a copay. Kidney disease education services have a 20% coinsurance, and other preventive services, such as glaucoma screenings, and diabetes self-management training, have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay for one visit per year each. Prescription hearing aids have a maximum plan benefit coverage of $500 per ear every year, while prescription hearing aids (all types) have no copay for two visits per year. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Advantra Eagle (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$15, while eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $300 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $15 copay, along with 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, but orthodontics, maxillofacial prosthetics, and implant services are not covered. There is a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Advantra Eagle (HMO) plan, but require prior authorization. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Aetna Medicare Advantra Eagle (HMO) plan. Durable Medical Equipment has a coinsurance of 0-20%, while Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies have a coinsurance of 0-20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic procedures and lab services have no copay, while diagnostic radiological services have a copay of up to $275 and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Eagle (HMO) plan with no copay and no coinsurance, but 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 Advantra Eagle (HMO) plan, but the specific services of 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. The plan has a copay for these services, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the Aetna Medicare Advantra Eagle (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other services include coverage for over-the-counter items and meal benefits with no copay, while acupuncture is not covered. Other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services.
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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.
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