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Aetna Medicare Eagle (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Eagle (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Eagle (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southwest Missouri. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Eagle (HMO-POS) 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 (HMO-POS).
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 (HMO-POS), 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 $150.00. 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 $3400.00 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 Eagle (HMO-POS).
Additional Benefits
The Aetna Medicare Eagle (HMO-POS) plan offers comprehensive medical coverage with many essential services requiring no copay and no coinsurance. Beneficiaries enjoy no copay or coinsurance for primary care doctor visits, routine preventive screenings, home health care, and laboratory services. For specialist visits, urgent care, and outpatient diagnostic procedures, patients will encounter low copays of up to $35 with no coinsurance. Inpatient hospital stays require daily copays for the first six days with no coinsurance, while emergency room visits carry a $150 copay that is waived if admitted. The plan also features generous dental, vision, and hearing benefits, providing routine exams with no copay or coinsurance. This includes up to a $3,500 annual dental maximum, a $350 allowance for eyewear, and coverage for prescription hearing aids up to $1,250 per ear.
Inpatient Hospital See details
Aetna Medicare Eagle (HMO-POS) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $395 copay per day for days 1-6 and no copay for additional days, while psychiatric stays require a $310 copay per day for days 1-6 and no copay for days 7-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle (HMO-POS) outpatient services are covered with no coinsurance, featuring a copay of $0 to $395 for outpatient hospital services and $395 per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $35 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Eagle (HMO-POS) covers partial hospitalization services with a copay of either $55.00 or $180.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services under the Aetna Medicare Eagle (HMO-POS) plan are covered with a $350 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport, with prior authorization required. Transportation services are not covered in practice, as trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Eagle (HMO-POS) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed care with a $35 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $250,000 maximum benefit, with copays of $150 for emergency or urgent care and $350 for emergency transportation.
Primary Care See details
Aetna Medicare Eagle (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and therapy services require copays up to $35 and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance, though routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Eagle (HMO-POS) plan, offering annual physicals, health education, and screenings with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance with no copay. Supplemental benefits such as weight management, personal emergency response systems, nutritional/dietary benefits, in-home safety assessments, and alternative therapies are not covered.
Hearing Services See details
Hearing services under the Aetna Medicare Eagle (HMO-POS) are partially covered, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay, coinsurance, or deductible for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, but OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Eagle (HMO-POS) with no copay and no coinsurance for both eye exams and eyewear. This benefit includes one routine eye exam per year and a $350 annual maximum allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle (HMO-POS), offering up to a $3,500 annual maximum with no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $35 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Eagle (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Eagle (HMO-POS) covers medical equipment with no copay and coinsurance ranging from no coinsurance to 20% depending on the item. This benefit includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment, all of which require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Eagle (HMO-POS), with prior authorization required. There is no copay or coinsurance for lab services and outpatient X-rays, while diagnostic procedures carry a $0 to $35 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Eagle (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Aetna Medicare Eagle (HMO-POS), as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage in practice. For these services, the plan lists a $5 copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Aetna Medicare Eagle (HMO-POS) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed for admission, additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Eagle (HMO-POS), with Dual Eligible SNPs and certain other services excluded from coverage. Covered benefits include acupuncture for a $20 copay and no coinsurance, alongside over-the-counter items, meal benefits, and select wellness screenings which all require no copay and no coinsurance.
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