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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 IL, IN, MI, WI. 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 $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 $8000.00 (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 $8000.00 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 with varying costs. Inpatient hospital stays have a $300 copay for the first six days, but no copay for subsequent days. Outpatient services range from no copay to $350, depending on the service. The plan also includes benefits for emergency services, primary care, preventive services, hearing, vision, and dental. Many services have no copay, while others have copays or coinsurance. Additionally, the plan covers home health services with no copay, and Skilled Nursing Facility (SNF) services with no copay for the first 20 days, and $214 per day for days 21-100.
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 $300 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $300 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient hospital services, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital services have a copay of $0-$350, observation services have a $350 copay, ambulatory surgical center services have no copay, individual and group outpatient substance abuse sessions have a $75 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, with a $65 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Eagle (PPO) plan. Ground Ambulance Services have a $290 copay, while Air Ambulance Services have a 20% coinsurance; however, Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Eagle (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. Physician specialist services have a $30 copay, while mental health and psychiatric individual and group sessions have a $40 copay. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $75. Opioid treatment program services are covered with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay and annual physical exams with no copay. Additional preventive services are covered, as well as kidney disease education services with a 20% coinsurance. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a plan-specified amount per period, up to $1500. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as 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 between $0 and $30, and eyewear with no copay, with a combined maximum benefit of $300 per year. Routine eye exams are covered with no copay for one visit every year, and other eye exam services, such as follow up diabetic eye exams, are covered with no copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and other dental services with a $3,500 maximum benefit per year. 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Eagle (PPO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Eagle (PPO) plan. Durable Medical Equipment (DME) has a coinsurance of 0-20% and requires authorization. Prosthetic Devices have a 20% coinsurance. Medical Supplies have a coinsurance of 0-20%. Diabetic Supplies have a coinsurance of 0-20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $75, and lab services with no copay. Radiological services include coverage for diagnostic radiological services with a copay of at most $250, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Eagle (PPO) plan with no copay and no coinsurance, but 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. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
The Aetna Medicare Eagle (PPO) plan covers Skilled Nursing Facility (SNF) services, but prior authorization is required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day, while additional days beyond Medicare coverage, and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Eagle (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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