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Aetna Medicare Advantra Eagle Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Eagle Plus (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 Plus (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Eagle Plus (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 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Eagle Plus (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 Plus (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 Plus (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 $115.00. 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:
Sign up for Aetna Medicare Advantra Eagle Plus (HMO)
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Drug Coverage
Prescription drugs are not covered by Aetna Medicare Advantra Eagle Plus (HMO).
Additional Benefits
The Aetna Medicare Advantra Eagle Plus (HMO) offers comprehensive medical coverage featuring no copay or coinsurance for primary care visits, while specialist consultations range from no copay up to a $15 copay. Inpatient hospital stays require a $295 daily copay for the first seven days of acute stays, whereas outpatient hospital services range from no copay up to a $250 copay. Emergency services are covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. Supplemental benefits include dental care with no copay up to a $3,000 annual limit, and vision services featuring no copay for eyewear up to a $300 yearly maximum. Routine hearing exams and fittings also have no copay, alongside a $500 annual allowance per ear for prescription hearing aids. Members can also take advantage of a $90 quarterly over-the-counter allowance and no copay for home health services.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Advantra Eagle Plus (HMO) with no coinsurance, featuring a $295 daily copay for days 1-7 of acute stays and a $176 daily copay for days 1-9 of psychiatric stays, with no copay for remaining covered days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Advantra Eagle Plus (HMO) are covered with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $250, observation services incur a $250 copay per stay, and outpatient substance abuse sessions have a $5 copay, with prior authorization required for several of these services.
Partial Hospitalization See details
Aetna Medicare Advantra Eagle Plus (HMO) covers partial hospitalization services with copays ranging from no copay up to $110, no coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $115 to $250, up to a $250,000 maximum plan benefit.
Primary Care See details
Primary care benefits are covered by the Aetna Medicare Advantra Eagle Plus (HMO) with no copay and no coinsurance for primary care visits, and a $0 to $15 copay with no coinsurance for specialist services. Most other covered services, such as physical therapy, podiatry, and mental health care, require a $5 to $15 copay with no coinsurance, though chiropractic care is only partially covered as other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by the Aetna Medicare Advantra Eagle Plus (HMO), with most covered benefits like annual physicals and diabetes training requiring no copay and no coinsurance. Kidney disease education is covered with no copay but carries a 20% coinsurance, while several supplemental services such as medical nutrition therapy, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers hearing services with a $15 copay and no coinsurance for Medicare-covered exams, while routine annual exams and fittings have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear yearly, but OTC hearing aids and prescription inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Advantra Eagle Plus (HMO) with no deductible and no coinsurance, featuring a $0 to $15 copay for eye exams and no copay for eyewear. This benefit includes one routine eye exam per year and a combined maximum coverage of $300 annually for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Advantra Eagle Plus (HMO) partially covers dental services, offering Medicare-covered dental care with a $15 copay and no coinsurance, alongside other covered preventive and comprehensive services with no copay or coinsurance up to a $3,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Advantra Eagle Plus (HMO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Aetna Medicare Advantra Eagle Plus (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests, lab services, and diagnostic radiology are available with no copay and no coinsurance, while outpatient X-rays require a $15 copay plus coinsurance, and therapeutic radiology requires a minimum 20% coinsurance plus a copay.
Home Health Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Advantra Eagle Plus (HMO) with no copay and no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Eagle Plus (HMO) 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, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Aetna Medicare Advantra Eagle Plus (HMO) partially covers other services with no copay and no coinsurance, including a $90 quarterly over-the-counter allowance, meal benefits for chronic illnesses, annual wellness exams, and select cancer screenings. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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