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Aetna Medicare Eagle (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle (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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Eagle (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Oklahoma and Texas Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Eagle (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 (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 (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. Additionally, this plan comes with a Part B Premium reduction of $110.00. 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 combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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 (PPO).
Additional Benefits
The Aetna Medicare Eagle (PPO) plan offers comprehensive coverage with varying costs based on the service. For inpatient hospital stays, you'll pay a copay for the initial days, with no copay for most of the stay. Outpatient services have a mix of copays, while preventive services like annual exams have no copay. The plan also includes coverage for hearing and vision services, with copays for hearing exams and no copay for eyewear. Dental services are included, with varying copays and coinsurance depending on the specific service. Prescription hearing aids are covered, with a maximum plan benefit of $1250 per year. The plan also offers additional benefits such as acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you have a $445 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you have a $375 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute is covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered; Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Eagle (PPO) plan, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $395, observation services have a $395 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group outpatient substance abuse sessions each have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, but requires prior authorization. The copay for this benefit is $85.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $270 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Eagle (PPO) plan with a $125 copay, and no coinsurance. Urgently Needed Services have a $55 copay and no coinsurance, while Worldwide Emergency Services have varying copays depending on the specific service.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay for routine care. Occupational therapy services have a $45 copay, while physician specialist services have a copay between $0 and $40. The plan also covers mental health and psychiatric services with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $45 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $55. Opioid treatment program services have a $40 copay.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, are covered with a $0 copay. Kidney Disease Education Services has a 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
The Aetna Medicare Eagle (PPO) plan covers hearing exams with a $40 copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1250 per year, and prescription hearing aids (all types) have no copay. OTC hearing aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
The Aetna Medicare Eagle (PPO) plan covers vision services, including eye exams and eyewear. Eye exams have no copay, and eyewear has no copay, with a combined maximum plan benefit of $300 every year for both in-network and out-of-network services.
Dental Services See details
Dental Services are covered. Medicare Dental Services have a $40 copay and require prior authorization, while other services include oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative Services, Adjunctive General Services, Periodontics, and Oral and Maxillofacial Surgery have a 20% - 50% coinsurance, Endodontics has a 20% coinsurance, Prosthodontics (removable) and Prosthodontics (fixed) have a 50% coinsurance. Orthodontic Services have a maximum benefit of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Eagle (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Eagle (PPO) plan, but prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Eagle (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay, and a coinsurance applies to Medicare-covered prosthetic devices and medical supplies. Diabetic supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $375, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Eagle (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 not covered by the Aetna Medicare Eagle (PPO) plan. While the plan covers some cardiac rehabilitation services, the specific services listed, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Eagle (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Eagle (PPO) plan covers acupuncture with a $20 copay, and over-the-counter items with no copay, up to a $50 benefit every three months. The plan also covers a meal benefit with no copay. Annual wellness exams, screening mammography, and gFOBT/FIT are covered with no copay. Many other services are not covered.
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