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Aetna Medicare Advantra Eagle (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Eagle (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra Eagle (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Eagle (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Kent, New Castle, Sussex counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Eagle (HMO) 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 Advantra Eagle (HMO).
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 Advantra Eagle (HMO), 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 $85.00. 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 $6750.00 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:
Sign up for Aetna Medicare Advantra Eagle (HMO)
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Drug Coverage
Prescription drugs are not covered by Aetna Medicare Advantra Eagle (HMO).
Additional Benefits
The Aetna Medicare Advantra Eagle (HMO) plan offers a wide array of benefits with varying cost-sharing. This plan covers inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $295, and ambulance services with a copay and coinsurance. It also includes no copay for primary care physician services, preventive services, hearing exams, and eyewear, with some services subject to copays or coinsurance. Additionally, the plan covers dental services up to a $2,500 annual maximum, home infusion services, and dialysis services with coinsurance. Other notable benefits include no copay for home health services, and skilled nursing facility services with a copay. However, it's important to note that certain services like cardiac rehabilitation services, and additional hours of care are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $295 for days 1-7 and no copay for days 8-90 for acute care, and a copay of $176 for days 1-9 and no copay for days 10-90 for psychiatric care; additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $295, and observation services with a $295 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $5 copay for both individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Aetna Medicare Advantra Eagle (HMO) covers partial hospitalization with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Under the Aetna Medicare Advantra Eagle (HMO) plan, ambulance services are covered, with a $250 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to plan-approved health-related locations are covered with no copay, up to 6 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Advantra Eagle (HMO) plan, with a $125 copay, and no coinsurance. Urgently Needed Services have a $50 copay, and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Coverage all have a $125 copay and no coinsurance, while Worldwide Emergency Transportation has a $250 copay and no coinsurance.
Primary Care See details
The Aetna Medicare Advantra Eagle (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $0-$15 copay, and mental health specialty services with a $5 copay. The plan also covers podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services with a $15 copay, additional telehealth benefits with a 20% coinsurance and a $0-$50 copay, and opioid treatment program services with a $5 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services are covered. Kidney disease education services have a 20% coinsurance, while additional services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Wigs for Hair Loss Related to Chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Aetna Medicare Advantra Eagle (HMO) plan covers hearing exams with a $15 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids (all types) are covered with no copay for up to two visits per year, with a maximum plan benefit of $500 per ear every year. Prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Advantra Eagle (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$15, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $300 per year.
Dental Services See details
Dental services are covered, with a $2,500 annual maximum. Medicare dental services require prior authorization and have a $15 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Advantra Eagle (HMO) plan, but require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Advantra Eagle (HMO) plan, with Durable Medical Equipment (DME) subject to a 0% to 20% coinsurance, and Prosthetics/Medical Supplies and Diabetic Supplies covered with a 0% to 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $275, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Eagle (HMO) 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 Advantra Eagle (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Eagle (HMO) plan. You will pay a copay of $10 for days 1-20, and a copay of $214 for days 21-100.
Other Services See details
Other services include coverage for over-the-counter items and meal benefits with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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