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Aetna Medicare Eagle (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Eagle (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Eagle (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Eagle (HMO-POS) 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 (HMO-POS).
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 (HMO-POS), 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 $60.00. 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 $5500.00 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:
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Drug Coverage
Prescription drugs are not covered by Aetna Medicare Eagle (HMO-POS).
Additional Benefits
The Aetna Medicare Eagle (HMO-POS) plan offers comprehensive coverage with many essential services requiring no copay and no coinsurance, including primary care visits, routine vision exams, and home health care. For specialized medical care, members will pay a $35 copay for specialist visits and a $130 copay for emergency room visits. Inpatient hospital stays require no coinsurance but do carry daily copays, such as $325 per day for the first six days of acute care. This plan also features robust supplemental benefits, including a $45 quarterly over-the-counter reimbursement and hearing aid coverage up to $1,250 per ear annually with no copay. Dental care includes select preventive services with no copay, while comprehensive dental services are covered up to a $1,500 annual limit with no copay and 20% to 50% coinsurance. Vision benefits also feature no copay or coinsurance, including a routine eye exam and up to $200 annually for eyewear.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Eagle (HMO-POS) with no coinsurance, requiring prior authorization. Acute stays require a $325 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $370 daily copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle (HMO-POS) outpatient services are covered with no coinsurance, featuring a copay of $0 to $325 for outpatient hospital services and $325 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Eagle (HMO-POS) plan with no coinsurance, though prior authorization is required. Depending on the service, you will owe a copay of either $55.00 or $145.00.
Ambulance and Transportation Services See details
Ambulance and transportation services under Aetna Medicare Eagle (HMO-POS) include ground ambulance services for a $245 copay and no coinsurance, and air ambulance services for a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to any plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency services under Aetna Medicare Eagle (HMO-POS) are covered with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $245.
Primary Care See details
Aetna Medicare Eagle (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $40 copay and no coinsurance, but podiatry and chiropractic services are not covered. Telehealth benefits are also available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Eagle (HMO-POS) plan, with most covered services like annual physical exams and health education requiring no copay and no coinsurance. While kidney disease education is covered with a 20% coinsurance and no copay, several supplemental benefits such as weight management, nutritional/dietary benefits, and personal emergency response systems are not covered.
Hearing Services See details
Aetna Medicare Eagle (HMO-POS) partially covers hearing services with no copay and no coinsurance for routine exams, fitting evaluations, and prescription hearing aids up to a $1,250 maximum benefit per ear every year. Over-the-counter (OTC) hearing aids, as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Eagle (HMO-POS) covers vision services with no copays and no coinsurance, including one routine eye exam per year and follow-up diabetic eye exams. Eyewear, including contact lenses, eyeglasses, frames, lenses, and upgrades, is also covered with no copay or coinsurance up to a $200 annual maximum benefit.
Dental Services See details
Aetna Medicare Eagle (HMO-POS) offers partially covered dental services, featuring Medicare dental care for a $35 copay and no coinsurance, alongside select preventive services with no copay and no coinsurance. Comprehensive services are covered up to a $1,500 annual maximum with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Eagle (HMO-POS) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Eagle (HMO-POS) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Eagle (HMO-POS) covers medical equipment, prosthetics, and diabetic supplies with no copay, though prior authorization is required. Depending on the specific item, coinsurance ranges from no coinsurance to 20%, with prosthetic devices and diabetic therapeutic shoes or inserts requiring a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle (HMO-POS) covers diagnostic and radiological services, with prior authorization required. Diagnostic procedures and tests have no coinsurance and a $0 to $20 copay, lab services have no copay, outpatient X-rays have a $20 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Eagle (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no coinsurance under the Aetna Medicare Eagle (HMO-POS) plan, where some services are covered but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered. These non-covered services require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, though the plan does not require a prior three-day inpatient hospital stay for admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services under the Aetna Medicare Eagle (HMO-POS) plan are partially covered with no copay and no coinsurance for eligible benefits, including chronic illness meals, annual wellness exams, and a $45 quarterly over-the-counter (OTC) reimbursement. Acupuncture and certain other services are not covered under this plan.
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