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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 Southwest FL. 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 $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 comprehensive coverage, including inpatient hospital stays with a $250 copay for days 1-7 and no copay for days 8-90, and outpatient services with copays ranging from $0 to $250. Emergency services have a $125 copay, and primary care visits are covered with no copay. This plan also provides additional benefits such as coverage for hearing exams, vision services, and dental services with a $1,000 annual maximum. Home health services, preventive services, and some diagnostic services are available with no copay. Additionally, the plan covers OTC items with a maximum benefit of $75 every three months and offers a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $250 for days 1-7 and no copay for days 8-90. Additional days for inpatient hospital acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, are covered by the Aetna Medicare Eagle (PPO) plan, with copays ranging from $0 to $250. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Eagle (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (PPO) plan. Ground ambulance services have a $250 copay, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Eagle (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay while Worldwide Emergency Transportation has a $250 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, occupational therapy services with a $40 copay, and specialist services with a $0-$40 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, and physical and speech therapy services have a $40 copay. Additional telehealth services have a 20% coinsurance and a $0-$40 copay, while opioid treatment services have a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services including annual physical exams with no copay. Additional preventive services are covered with a $0 copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. The plan also covers Kidney Disease Education Services with 20% coinsurance.
Hearing Services See details
Hearing Services for the Aetna Medicare Eagle (PPO) plan include coverage for hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum copay of $1700.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $40, routine eye exams with no copay, and other eye exam services with no copay. Eyewear is covered with no copay, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum of $200 per year.
Dental Services See details
Dental services are covered, 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 a $1,000 annual maximum and no copay for most services. 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. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Eagle (PPO) plan, and prior authorization is required. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
The Aetna Medicare Eagle (PPO) plan covers Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and it covers Prosthetics, Medical Supplies, and Diabetic Equipment, with specific cost-sharing details outlined in the plan's documentation. 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 $75, lab services with no copay, diagnostic radiological services with a copay up to $200, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay. Prior authorization is required.
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 covered by the Aetna Medicare Eagle (PPO) plan, but the details of the copay are not specified. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Eagle (PPO) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Eagle (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $75 every three months, and a meal benefit with no copay. The plan does not cover acupuncture, and the following additional services are not covered: Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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