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Aetna Medicare Eagle (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle (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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Eagle (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Eagle (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 (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 (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 $40.00. 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 $7750.00 (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 $7750.00 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:
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Drug Coverage
Prescription drugs are not covered by Aetna Medicare Eagle (PPO).
Additional Benefits
The Aetna Medicare Eagle (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a copay. The plan also covers primary care with no copay, preventive services with no copay for many services, and provides coverage for home health services, medical equipment, and diagnostic services, often with no copay or a coinsurance. The plan has some limitations, such as not covering certain services like cardiac rehabilitation and does not cover routine chiropractic care or podiatry services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with prior authorization required. For Inpatient Hospital-Acute, you pay a $374 copay for days 1-8, and no copay for days 9-90. For Inpatient Hospital Psychiatric, you pay a $286 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services with the Aetna Medicare Eagle (PPO) plan includes coverage for outpatient hospital services with a copay between $0 and $374, observation services with a $374 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Eagle (PPO) with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $275 copay, and air ambulance services with 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Eagle (PPO) plan, with a $125 copay for emergency services and a $45 copay for urgently needed services. Worldwide Emergency Coverage, Urgent Coverage, and Emergency Transportation are also covered, with copays of $125 and $275 respectively.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, and occupational therapy services have a $30 copay. Physician specialist services have a copay between $0 and $35, and physical therapy and speech-language pathology services have a $30 copay. Individual and group sessions for mental health and psychiatric services have a $40 copay. Other health care professional services have a copay between $0 and $35. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services, including an annual physical exam with no copay, and other services like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $1250 per year, and prescription hearing aids (all types) are covered with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Eagle (PPO) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay, up to a combined maximum of $200 per year for both in and out-of-network services. Routine eye exams are covered with no copay, up to 1 per year.
Dental Services See details
The Aetna Medicare Eagle (PPO) plan covers dental services with a $2,000 annual maximum, including 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 with 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Eagle (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment and prosthetics/medical supplies, is covered by the Aetna Medicare Eagle (PPO) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $120, and lab services with no copay. Radiological services are covered, including diagnostic radiological services with a maximum copay of $200, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $14 copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Eagle (PPO) plan with no copay and no coinsurance. However, 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 (PPO) plan. While the plan covers some services, the specific Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Eagle (PPO) plan, but require prior authorization. You will pay a copay of $10 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Eagle (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $45 every three months. Other services like acupuncture, meal benefits, annual wellness exams, screening mammography, gFOBT, and FIT are also covered, but Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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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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