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Aetna Medicare Advantra Eagle Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Eagle Plus (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 Plus (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Eagle Plus (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 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Eagle Plus (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 Plus (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 Plus (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 Plus (HMO)
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Drug Coverage
Prescription drugs are not covered by Aetna Medicare Advantra Eagle Plus (HMO).
Additional Benefits
The Aetna Medicare Advantra Eagle Plus (HMO) plan offers comprehensive health coverage with no copay and no coinsurance for primary care physician visits, annual physicals, and wellness screenings. For specialized care, inpatient hospital stays require a daily copay of $295 for the first seven days, while emergency room visits carry a $130 copay that is waived if you are admitted. Outpatient hospital services feature copays ranging from no copay up to $295, with no coinsurance required. This plan also includes valuable supplemental benefits, featuring preventive and comprehensive dental care with no copay or coinsurance up to a $2,500 annual limit. Members also receive routine eye and hearing exams with no copay, alongside a $300 annual eyewear allowance and a $500 yearly prescription hearing aid benefit per ear. Additional perks include six one-way transportation trips per year and a $90 quarterly over-the-counter reimbursement allowance with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Advantra Eagle Plus (HMO) with no coinsurance, requiring a $295 daily copay for days 1-7 of acute stays and a $176 daily copay for days 1-9 of psychiatric stays, followed by no copay for subsequent days. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers outpatient services with no coinsurance, featuring a $0 to $295 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services carry a $5 copay per individual or group session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Advantra Eagle Plus (HMO) with no coinsurance, although prior authorization is required. Depending on the service, you will pay either no copay or a $145 copay.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Aetna Medicare Advantra Eagle Plus (HMO) plan, with ground ambulance services requiring a $300 copay (no coinsurance) and air ambulance services requiring 20% coinsurance (no copay). Transportation services are partially covered, offering up to 6 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency care, urgent care, and emergency transportation are also covered with no coinsurance up to a $250,000 benefit limit, with copays of $130, $130, and $300 respectively.
Primary Care See details
Primary Care benefits under the Aetna Medicare Advantra Eagle Plus (HMO) are partially covered, offering primary care physician visits with no copay and no coinsurance, while specialist, therapy, and mental health services carry copays between $0 and $15 with no coinsurance. While routine chiropractic care is covered for a $15 copay, other chiropractic services are not covered, and additional telehealth services require a 20% coinsurance and copays up to $50.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Advantra Eagle Plus (HMO), offering no copay and no coinsurance for annual physicals, wellness screenings, and fitness benefits, while kidney disease education has no copay and a 20% coinsurance. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Advantra Eagle Plus (HMO), offering Medicare-covered exams for a $15 copay and no coinsurance, and annual 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 hearing aids and 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 Advantra Eagle Plus (HMO) with no coinsurance, featuring eye exams with a copay of $0 to $15 and no copay for annual routine exams. Eyewear is also covered with no copay and no coinsurance, providing up to a $300 annual maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Aetna Medicare Advantra Eagle Plus (HMO) offers partially covered dental services, with Medicare-covered dental requiring a $15 copay and no coinsurance, and other covered preventive and comprehensive services having no copay and no coinsurance up to a $2,500 yearly maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
The Aetna Medicare Advantra Eagle Plus (HMO) plan covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Advantra Eagle Plus (HMO) with no copay, though prior authorization is required. Patients will pay no coinsurance to 20% coinsurance for durable medical equipment, medical supplies, and diabetic supplies, and a flat 20% coinsurance for prosthetics and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Advantra Eagle Plus (HMO), with prior authorization required for these services. Diagnostic tests, lab services, and diagnostic radiology are available with no copay and no coinsurance, while outpatient X-rays require a $20 copay plus coinsurance and therapeutic radiology requires 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Advantra Eagle Plus (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Advantra Eagle Plus (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Eagle Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Aetna Medicare Advantra Eagle Plus (HMO) offers coverage for several other services with no copay and no coinsurance, including a chronic illness meal benefit, screening mammographies, and a $90 quarterly over-the-counter reimbursement allowance. Acupuncture is not covered under this plan.
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