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Aetna Medicare Eagle Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle Plus (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 (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Eagle Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties Across AL. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Eagle Plus (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 (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 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $13900.00 (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 $13900.00 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 (PPO)
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Drug Coverage
Prescription drugs are not covered by Aetna Medicare Eagle Plus (PPO).
Additional Benefits
The Aetna Medicare Eagle Plus (PPO) plan provides comprehensive medical coverage with predictable out-of-pocket costs. Members enjoy no copay for primary care doctor visits, while specialist visits range from no copay to a $25 copay with no coinsurance. For hospital needs, inpatient stays require a $299 daily copay for days one through seven, and emergency room care is covered with a $115 copay. This plan also features excellent supplemental benefits, including preventive dental, routine vision, and annual hearing exams with no copay. Additional perks include a $300 annual eyewear allowance, a $500 annual hearing aid allowance per ear, and a $180 quarterly credit for over-the-counter items with no copay. Skilled nursing care is also highly affordable, requiring no copay for the first 20 days of your stay.
Inpatient Hospital See details
Aetna Medicare Eagle Plus (PPO) partially covers inpatient hospital benefits with no coinsurance, charging a $299 daily copay for days 1 to 7 of acute stays and a $407 daily copay for days 1 to 5 of psychiatric stays, followed by no copay. Upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Eagle Plus (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Other covered benefits require copays, including $0 to $325 for outpatient hospital services, $299 per stay for observation services, and $30 per session for outpatient substance abuse services.
Partial Hospitalization See details
Aetna Medicare Eagle Plus (PPO) covers partial hospitalization services with a copay ranging from $105.00 to $110.00 and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Eagle Plus (PPO) covers ambulance services with prior authorization, which require a $270 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Eagle Plus (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, and worldwide emergency services are covered up to a $250,000 maximum benefit with copays between $115 and $270 and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Eagle Plus (PPO), as podiatry services and routine chiropractic care are not covered. Covered services feature no coinsurance, with no copay for primary care visits, no copay to a $25 copay for specialists, and a $20 copay for therapy services. Additional telehealth services are available with a 20% coinsurance and a copay ranging from no copay to $40.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Eagle Plus (PPO), with most covered services—including annual physicals, glaucoma screenings, and fitness benefits—offered with no copay and no coinsurance. Kidney disease education is covered with a 20% coinsurance and no copay, but several supplemental sub-services, including personal emergency response systems, weight management, therapeutic massage, and alternative therapies, are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle Plus (PPO), which offers Medicare-covered exams for a $25 copay, routine exams and fittings for no copay, and no deductibles or coinsurance. Prescription hearing aids (all types) are covered up to $500 per ear annually with no copay, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Eagle Plus (PPO) covers vision services with no deductibles and no coinsurance. Eye exams are available for a $0 to $25 copay up to a $50 annual limit, and eyewear is covered with no copay up to a $300 yearly maximum.
Dental Services See details
Aetna Medicare Eagle Plus (PPO) provides partially covered dental services, with no coverage for fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics. Preventive care features no copay and no coinsurance, Medicare-covered dental services require a $25 copay and no coinsurance, and other covered comprehensive services have a 20% to 50% coinsurance and no copay up to a $4,000 annual limit.
Home Infusion bundled Services See details
Aetna Medicare Eagle Plus (PPO) covers home infusion bundled services, which require prior authorization and may involve step therapy. Patients pay a $35 copay with no coinsurance for Medicare Part B insulin, and no copay with 0% to 20% coinsurance for chemotherapy, radiation, and other Part B drugs.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Eagle Plus (PPO) plan with 20% coinsurance and no copay, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Eagle Plus (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required for most services. Members pay a coinsurance ranging from 0% to 20% with no copay for DME, medical supplies, and diabetic supplies, a 20% coinsurance and no copay for prosthetics, and no copay or coinsurance for diabetic therapeutic shoes and inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Eagle Plus (PPO) and require prior authorization. Outpatient X-rays and lab services have no copay or coinsurance, while diagnostic tests carry a $0 to $95 copay, diagnostic radiology has a $0 to $300 copay, and therapeutic radiology requires 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Eagle Plus (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Eagle Plus (PPO) plan, as none of the sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered. Consequently, there is no plan coverage, copay, or coinsurance for these rehabilitation services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle Plus (PPO) partially covers Skilled Nursing Facility (SNF) services, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Eagle Plus (PPO), featuring no copay and no coinsurance for covered services such as meal benefits, wellness exams, and up to $180 in over-the-counter items every three months. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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