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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 Select Counties in GA. This plan received an overall rating of 3.5 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:
Sign up for Aetna Medicare Eagle Plus (PPO)
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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 robust health coverage featuring no copay and no coinsurance for primary care doctor visits, routine eye exams, and preventive dental care. For hospital care, inpatient acute stays require a $489 daily copay for the first five days and no copay thereafter, while emergency room visits have a $115 copay. Specialist visits and diagnostic services are highly affordable, with copays ranging from no copay up to $50 for specialists and no copay for laboratory services. This plan also includes valuable supplemental benefits, such as a $350 annual allowance for eyewear with no copay, and prescription hearing aid coverage up to $500 per ear. Comprehensive dental care is covered with no copay and 20% to 50% coinsurance up to a generous $4,000 annual limit. Additionally, members benefit from a quarterly over-the-counter reimbursement allowance of up to $105 with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Eagle Plus (PPO) inpatient hospital benefits are partially covered with no coinsurance, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For covered acute stays, there is a $489 daily copay for days 1 through 5 and no copay for day 6 and beyond, while psychiatric stays require a $407 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Aetna Medicare Eagle Plus (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services range from no copay to a $489 copay, while observation services require a $489 copay per stay and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Eagle Plus (PPO) with a copay of $105.00 or $110.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Eagle Plus (PPO) covers ground ambulance services with a $250 copay and air ambulance services with a 20% coinsurance, with prior authorization required. Transportation services to health-related locations 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 are covered with a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $250.
Primary Care See details
Primary care benefits under Aetna Medicare Eagle Plus (PPO) are partially covered, featuring no copay and no coinsurance for primary care physician visits, and copays ranging from $0 to $50 with no coinsurance for specialists, mental health, and therapy services. Podiatry and routine chiropractic services are not covered, and additional telehealth benefits require a 20% coinsurance and a $0 to $50 copay.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Eagle Plus (PPO), offering no copay and no coinsurance for annual exams, diabetes training, and glaucoma screenings, though kidney disease education requires a 20% coinsurance and no copay. While supplemental benefits like memory fitness and chemotherapy wigs (up to $400 yearly) have no copay and no coinsurance, several services including personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered under the Aetna Medicare Eagle Plus (PPO), which features Medicare-covered exams for a $50 copay and no coinsurance, as well as routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Eagle Plus (PPO) with no coinsurance, featuring a $0 to $50 copay for eye exams and no copay for eyewear. Covered benefits include one routine eye exam per year at no copay and a $350 annual allowance for contacts, eyeglasses, frames, and upgrades with no deductible.
Dental Services See details
Aetna Medicare Eagle Plus (PPO) offers partially covered dental services, featuring no copay and no coinsurance for preventive care like cleanings, exams, and x-rays, and a $50 copay with no coinsurance for Medicare-covered dental. Comprehensive dental care, including restorative, endodontic, and periodontic treatments, is covered with no copay and 20% to 50% coinsurance up to a $4,000 annual limit, though fluoride, 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 and step therapy may apply. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Eagle Plus (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Eagle Plus (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic therapeutic shoes and inserts feature no copay, while diabetic supplies are covered with no coinsurance to 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle Plus (PPO) covers diagnostic services with no coinsurance, offering no copay for lab work and a copay between $0 and $95 for diagnostic tests and procedures. Covered radiological services feature no copay for outpatient X-rays and diagnostic radiology, though therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Eagle Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Eagle Plus (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though in practice some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Because these specific sub-services are not covered, there are no copays associated with them.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but not requiring a 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 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 chronic illness meal benefit, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings. Over-the-counter (OTC) items are also covered with no copay and no coinsurance up to a $105 maximum limit every three months via reimbursement, while acupuncture is not covered.
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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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