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Aetna Medicare Eagle Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle Plus (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 Plus (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Eagle Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Statewide - GA. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Eagle Plus (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 Plus (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 Plus (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.
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.
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 $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
Prescription drugs are not covered by Aetna Medicare Eagle Plus (PPO).
Additional Benefits
The Aetna Medicare Eagle Plus (PPO) plan offers a wide range of benefits. This plan covers inpatient hospital stays with a copay, and outpatient services with varying copays. Additionally, the plan includes coverage for ambulance services, emergency services, and a variety of primary care, preventive, hearing, vision, and dental services, all with specific copayments or no copays. This plan provides additional benefits like home health services with no copay, medical equipment with coinsurance, and diagnostic and radiological services with copays. It also offers over-the-counter items and a meal benefit with no copay, along with coverage for skilled nursing facilities, and other specific services, while other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $380 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services have a copay of $407 for days 1-5 and no copay for days 6-90, while additional days and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Eagle Plus (PPO) plan. Outpatient Hospital Services have a copay between $0 and $380, and Observation Services have a $380 copay. Ambulatory Surgical Center (ASC) Services, Individual Sessions, and Group Sessions all have a $25 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Eagle Plus (PPO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle Plus (PPO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Eagle Plus (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Aetna Medicare Eagle Plus (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $25 copay. The plan also covers mental health specialty services with a $30 copay for individual and group sessions, other health care professional services with a copay between $0 and $35, psychiatric services with a $30 copay for individual and group sessions, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services with a $30 copay. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Eagle Plus (PPO) plan covers preventive services, including an annual physical exam with no copay, and other services such as Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. Kidney Disease Education Services are covered with 20% coinsurance.
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 $35 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a maximum plan benefit coverage of $500 per year, per ear.
Vision Services See details
Vision services include eye exams and eyewear, with no coinsurance. Eye exams have a copay of $0-$35, and routine eye exams have a copay of $0 for one visit per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have a copay of $0, with a combined maximum benefit of $350 per year.
Dental Services See details
Dental services are covered, with a $35 copay for Medicare dental services, and a $2,000 maximum benefit per year for both in-network and out-of-network services. 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Eagle Plus (PPO) plan and require prior authorization. The plan has a $35 copay for Medicare Part B Insulin Drugs, and coinsurance applies to Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Eagle Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered, with a copay of at most $95 for diagnostic procedures/tests, and no copay for lab services. Radiological Services, including diagnostic and therapeutic radiological services, and outpatient X-ray services are covered, with a copay of at most $300 for diagnostic radiological services, no copay for outpatient X-ray services, and a coinsurance of 20% for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Eagle Plus (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 technically covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. The plan has a copay for some Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Eagle Plus (PPO) plan. There is no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Eagle Plus (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $90 every three months, and also covers a Meal Benefit with no copay. Acupuncture, 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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