A non-government entity
Aetna Medicare Eagle Plus II (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle Plus II (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 Plus II (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Eagle Plus II (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern California. The overall rating for this plan is not yet available for 2025.
It's important to know that Aetna Medicare Eagle Plus II (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 Plus II (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 Plus II (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 $25.00. 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 $9500.00 (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 $9500.00 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:
Sign up for Aetna Medicare Eagle Plus II (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Aetna Medicare Eagle Plus II (PPO).
Additional Benefits
The Aetna Medicare Eagle Plus II (PPO) plan offers comprehensive coverage for inpatient and outpatient services, including no copays for primary care, preventive services, vision, and many dental services. This plan includes a $375 copay for inpatient hospital stays (days 1-4), and a $265 copay for ground ambulance services. Additional benefits include hearing aid coverage, a maximum annual dental benefit of $3,000, and coverage for various therapies with copays ranging from $15 to $60.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-4, and no copay for days 5-90. For Inpatient Hospital Psychiatric, you will pay a $375 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services and observation services, with copays ranging from $0 to $375, and a $375 copay, respectively. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle Plus II (PPO) plan, and requires prior authorization. There is a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle Plus II (PPO) plan. Ground ambulance services have a $265 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, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Eagle Plus II (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $265 copay.
Primary Care See details
The Aetna Medicare Eagle Plus II (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a $20 copay. Physician specialist services have a copay between $0 and $40. Mental health and psychiatric services each have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, and other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Additional preventive services may have a copay, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit.
Hearing Services See details
The Aetna Medicare Eagle Plus II (PPO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $1250.00 every year, but the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear, and does not cover OTC hearing aids.
Vision Services See details
Vision Services, including eye exams and eyewear, are covered with no copay. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $75 per year.
Dental Services See details
Dental Services include a $40 copay for Medicare Dental Services, 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. The plan has a maximum benefit of $3,000 per year for in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Eagle Plus II (PPO) plan. 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 by the Aetna Medicare Eagle Plus II (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and authorization required, Prosthetics/Medical Supplies with 0-20% coinsurance, and Diabetic Equipment. The plan covers Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services. Diagnostic Procedures/Tests have a copay between $0 and $10, and Diagnostic Radiological Services have a copay up to $150. Therapeutic Radiological Services have a 20% coinsurance, and lab services and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Eagle Plus II (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 Plus II (PPO) plan. Some services listed under this benefit are not covered, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Eagle Plus II (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $203 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services for the Aetna Medicare Eagle Plus II (PPO) plan includes coverage for Over-the-Counter (OTC) Items and Other 1 and Other 2 services, with no copay for OTC Items and Other 1 and Other 2. Acupuncture, Meal Benefit, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved