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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 2026, 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 2026.
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 $13900.00 (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 $13900.00 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 comprehensive medical coverage with no copay or coinsurance for primary care visits, routine physicals, and home health services. Specialist visits require a low copay of up to $35, while inpatient hospital stays and emergency room visits feature set copays and no coinsurance. Outpatient and diagnostic services are also highly accessible, featuring no coinsurance and many options with no copay. For supplemental care, the plan provides dental and vision benefits with no copay for preventive services and routine examinations. Members receive a $350 annual allowance for eyewear and up to $4,000 yearly for comprehensive dental care with no copay and varied coinsurance. Additional perks include a $150 quarterly over-the-counter allowance, hearing aid coverage up to $500 per ear, and no copays for routine hearing exams.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Eagle Plus (PPO) with no coinsurance and require prior authorization, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $380 copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric stays require a $407 copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
Outpatient Services under the Aetna Medicare Eagle Plus (PPO) are covered with no coinsurance across all categories, featuring no copay for ambulatory surgical center and blood services. Medicare-covered outpatient hospital services require a copay ranging from $0 to $380, observation services have a $380 copay per stay, and outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
Aetna Medicare Eagle Plus (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Eagle Plus (PPO) covers ambulance services with prior authorization, requiring a $250 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services are not covered under this plan.
Emergency Services See details
Aetna Medicare Eagle Plus (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 lifetime maximum with no coinsurance and copays ranging from $115 to $250.
Primary Care See details
Aetna Medicare Eagle Plus (PPO) features primary care doctor visits with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Therapy, mental health, psychiatric, and opioid treatment services have copays ranging from $30 to $50 with no coinsurance, while telehealth carries a $0 to $50 copay and 20% coinsurance; podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Eagle Plus (PPO), offering no copay and no coinsurance for annual physicals, glaucoma screenings, and select wellness benefits like fitness and health education. While kidney disease education requires a 20% coinsurance with no copay, several supplemental benefits are not covered, including in-home safety assessments, personal emergency response systems, weight management, and nutritional therapy.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle Plus (PPO), with Medicare-covered exams requiring a $35 copay and no coinsurance, and annual routine exams and fitting evaluations costing no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear yearly with no copay or coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Eagle Plus (PPO) covers vision services with no deductibles, offering eye exams with a $0 to $35 copay and no coinsurance, which includes one annual routine exam with no copay. Eyewear benefits, including contact lenses, frames, and upgrades, also feature no copay and no coinsurance up to a combined annual maximum of $350.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Eagle Plus (PPO), featuring no copay and no coinsurance for preventive care, and a $35 copay with no coinsurance for Medicare-covered dental. Comprehensive services are available with no copay and 20% to 50% coinsurance up to a $4,000 yearly limit, though fluoride, other diagnostic/preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle Plus (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other drugs require a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Eagle Plus (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Aetna Medicare Eagle Plus (PPO) covers medical equipment, offering durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies feature no coinsurance to 20% coinsurance, and diabetic therapeutic shoes or inserts are covered with no copay, though prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Eagle Plus (PPO) subject to prior authorization, featuring no coinsurance for diagnostic services with a $0 to $95 copay for procedures and no copay for lab services. Radiological services range from no copay for X-rays and a $0 minimum copay for diagnostic radiology to a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered under the Aetna Medicare Eagle Plus (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Eagle Plus (PPO) features no coinsurance for Cardiac Rehabilitation Services; however, some services are covered while Cardiac Rehabilitation ($25 copay), Intensive Cardiac Rehabilitation ($25 copay), Pulmonary Rehabilitation ($15 copay), and Supervised Exercise Therapy for PAD ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle Plus (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 Plus (PPO) partially covers other services with no copay and no coinsurance, including a $150 quarterly over-the-counter reimbursement, meal benefits for chronic illness, and annual wellness exams. Acupuncture is not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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