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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 2026, 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 IL, IN, MI, WI. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $70.00. 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 $10100.00 (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 $10100.00 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 strong coverage for everyday medical needs, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a $30 copay, while inpatient hospital stays cost a $300 daily copay for the first six days and no copay thereafter. Outpatient services are covered with no coinsurance and copays ranging from no copay up to $300. This plan also includes robust dental, vision, and hearing benefits, featuring no deductibles and no copays for routine eye exams, eyewear up to $300, and preventive dental care. Hearing aids are covered up to $1,500 per ear with no copay, and members receive a $100 quarterly over-the-counter allowance. Emergency care is accessible with a $130 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Aetna Medicare Eagle (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copays, and outpatient hospital services with copays ranging from no copay up to $300. Outpatient substance abuse services require a $40 copay and observation services carry a $300 copay per stay, both with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Eagle (PPO) covers partial hospitalization services with a copay of either $65.00 or $145.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Eagle (PPO) covers ground ambulance services with a $290 copay and air ambulance services with a 20% coinsurance, both of which require prior authorization, while routine transportation services are not covered.
Emergency Services See details
Aetna Medicare Eagle (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services feature a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays of $130, $130, and $290 respectively.
Primary Care See details
Aetna Medicare Eagle (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits, physical therapy, and occupational therapy for a $30 copay and no coinsurance. Mental health and psychiatric services carry a $40 copay and no coinsurance, while telehealth services range from a $0 to $45 copay with 20% coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Eagle (PPO) offers partial coverage for preventive services, featuring no copay and no coinsurance for annual physicals, health education, fitness benefits, and select screenings. Kidney disease education is covered with no copay but carries a 20% coinsurance, while several supplemental benefits, such as weight management, alternative therapies, and in-home safety assessments, are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle (PPO) with no deductible, requiring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Up to $1,500 per ear annually is covered for prescription hearing aids with no copay or coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Eagle (PPO) covers vision services with no coinsurance and no deductible, featuring eye exams with copays ranging from no copay to $30.00. Routine eye exams, follow-up diabetic eye exams, and eyewear—including lenses, frames, and contacts—all feature no copay, with eyewear covered up to a $300.00 combined annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle (PPO) with an annual maximum benefit of $3,750 for both in-network and out-of-network services. Medicare-covered dental services require a $30 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Eagle (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic therapeutic shoes or inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Eagle (PPO), featuring no copay or coinsurance for lab services and diagnostic procedures ranging from a $0 to $75 copay with no coinsurance. Outpatient X-rays require a $20 copay, therapeutic radiological services carry a 20% coinsurance, and prior authorization is required for these benefits.
Home Health Services See details
Home health services are covered by Aetna Medicare Eagle (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Aetna Medicare Eagle (PPO), but only some services are covered in practice. Specific services that are not covered include Cardiac Rehabilitation (which has a $20 copay), Intensive Cardiac Rehabilitation ($20 copay), Pulmonary Rehabilitation ($15 copay), and Supervised Exercise Therapy for PAD ($25 copay).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and requires no prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Eagle (PPO) plan, offering no copay and no coinsurance for covered benefits such as chronic illness meal services, annual wellness exams, additional cancer screenings, and a $100 quarterly over-the-counter item allowance. Acupuncture is not covered under this plan.
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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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