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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 2026, 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 2026.
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 provides comprehensive medical coverage featuring no copay for primary care doctor visits and specialist copays ranging up to $40 with no coinsurance. Inpatient hospital stays require daily copays for the first six days of acute or psychiatric care, after which there is no copay. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Supplemental benefits are a key highlight, offering no copay or coinsurance for routine dental, vision, and hearing exams. Prescription hearing aids are covered up to $1,000 per ear annually, while comprehensive dental services are covered up to a $1,500 yearly limit with 20% to 50% coinsurance. Members also receive home health services at no copay and a $45 over-the-counter item allowance every three months.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Eagle (PPO) with no coinsurance, requiring a $445 daily copay for days 1-6 of acute stays (no copay for days 7 and beyond) and a $375 daily copay for days 1-6 of psychiatric stays (no copay for days 7-90). The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a $0 to $400 copay, observation services have a $445 copay per stay, and outpatient substance abuse sessions carry a $40 copay, all with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Eagle (PPO) covers partial hospitalization services with a copay of either $85.00 or $145.00 and no coinsurance, depending on the service. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by Aetna Medicare Eagle (PPO), featuring a $320 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Prior authorization is required for all ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Eagle (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are covered up to a $250,000 maximum with a $130 copay, while worldwide emergency transportation has a $320 copay, with no coinsurance required for these benefits.
Primary Care See details
Aetna Medicare Eagle (PPO) offers partially covered primary care benefits, featuring no copay and no coinsurance for primary care visits, and copays between $0 and $40 with no coinsurance for specialist, mental health, and therapy services. Routine chiropractic care is covered at a $15 copay with no coinsurance, while podiatry and other chiropractic services are not covered. Telehealth options are also available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Eagle (PPO), offering no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes training, and select supplemental benefits like fitness and nursing hotlines. However, kidney education requires a 20% coinsurance with no copay, and several options—including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs—are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle (PPO), with Medicare-covered exams requiring a $40 copay and no coinsurance, while routine exams and fittings have no copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to $1,000 per ear annually, but OTC hearing aids, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Eagle (PPO) vision services are covered with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This benefit includes a $50 annual maximum for eye exams, which covers one routine exam yearly, and a $275 annual combined maximum for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle (PPO), featuring preventive care with no copay and no coinsurance, and Medicare-covered dental for a $40 copay and no coinsurance. Comprehensive services are covered up to a $1,500 annual limit with no copay and 20% to 50% coinsurance, though other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Eagle (PPO) with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Eagle (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment with no copays, though coinsurance ranges from 0% to 20% for durable medical equipment, medical supplies, and diabetic supplies. Prosthetic devices require a 20% coinsurance, diabetic shoes and inserts have no copay, and prior authorization is required for most services.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a copay of $0 to $50 for diagnostic tests. Covered radiological services include diagnostic radiology and outpatient X-rays with no copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
The Aetna Medicare Eagle (PPO) plan covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Eagle (PPO) with no coinsurance, but in practice, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, but a prior three-day hospital stay is not, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Aetna Medicare Eagle (PPO) covers acupuncture with a $20 copay and no coinsurance, limited to 20 treatments per year. The plan also provides a meal benefit for chronic illness, annual wellness exams, and up to $45 every three months for over-the-counter items, all with no copay and no coinsurance.
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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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