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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 New England. 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 $60.00. 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:
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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 a range of benefits with varying costs. Hospital stays have copays, while outpatient services may have copays between $0 and $345. The plan also covers ambulance services, emergency services, and various therapies with copays or coinsurance. Preventive services are generally covered with no copay, including exams and screenings, while hearing, vision, and dental services have copays. The plan also covers home health services and skilled nursing facilities with copays, and offers benefits for durable medical equipment and prescription drugs.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $345 for days 1-6 and no copay for days 7-90 for acute care, and a copay of $435 for days 1-5 and no copay for days 6-90 for psychiatric care. Additional days and upgrades for inpatient hospital-acute and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $345, observation services with a $345 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, with a $60 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (PPO) plan. Ground Ambulance Services have a $270 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Eagle (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $270 copay; all services have no coinsurance.
Primary Care See details
For the Aetna Medicare Eagle (PPO) plan, primary care physician services have no copay, chiropractic services have a $15 copay, and occupational therapy services have a $40 copay. Physician specialist services and other health care professionals have a copay between $0 and $40. Mental health and psychiatric services have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $40.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, as well as health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance. In-home safety assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, post-discharge in-home medication reconciliation, re-admission prevention, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, counseling services, therapeutic massage, adult day health services, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum copay of $1700 for all types, but inner ear, outer ear, and over the ear prescription hearing aids 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 between $0 and $40, and eyewear with no copay. Eyewear benefits have a combined maximum plan benefit of $300 every year.
Dental Services See details
The Aetna Medicare Eagle (PPO) plan covers dental services, including Medicare Dental Services with a $40 copay, and other services like oral exams, dental x-rays, cleanings, fluoride treatments, restorative services, and more with no copay. However, the plan does not cover maxillofacial prosthetics, implant services, or orthodontics. There is a $2,000 maximum benefit per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Eagle (PPO) plan and require prior authorization. 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 under the Aetna Medicare Eagle (PPO) plan. There is a 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
The Aetna Medicare Eagle (PPO) plan covers Durable Medical Equipment with 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 0-20% coinsurance, and Diabetic Equipment, including Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside of the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic procedures have a copay between $0 and $45, lab services have no copay, and diagnostic radiological services have a coinsurance of up to 20% with no minimum coinsurance. Therapeutic radiological services have a coinsurance of up to 20% with a minimum coinsurance of 20%, while outpatient X-ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Eagle (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 (PPO) plan. Although the plan covers some Cardiac Rehabilitation Services, none of the sub-services are 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. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Eagle (PPO) plan covers over-the-counter items and meal benefits with no copay. Acupuncture 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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