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Aetna Medicare Eagle Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle Giveback (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 Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Eagle Giveback (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Metro Area: LI, 5 Boroughs, Westchester/Rockland. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Eagle Giveback (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 Giveback (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 Giveback (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 $75.00. 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 $13900.00 (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 $13900.00 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 Giveback (PPO).
Additional Benefits
The Aetna Medicare Eagle Giveback (PPO) offers robust medical coverage featuring no copay and no coinsurance for primary care doctor visits, while specialist visits require no copay or a copay up to $35. For hospital care, inpatient acute stays carry a $395 daily copay for the first six days with no coinsurance, and emergency room visits have a $115 copay which is waived if you are admitted. Outpatient surgical services and diagnostic lab tests are also highly accessible, requiring no copay and no coinsurance. This plan also includes key lifestyle benefits, such as routine dental, vision, and hearing exams with no copay. Members receive a $200 annual allowance for eyewear, up to $1,500 annually for preventive and comprehensive dental care with no copay, and a $60 quarterly over-the-counter allowance. Additionally, home health services are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Eagle Giveback (PPO) covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 to 6 of acute stays and a $346 daily copay for days 1 to 6 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and certain services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle Giveback (PPO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services require a $0 to $500 copay and observation services incur a $395 copay per stay, both with no coinsurance.
Partial Hospitalization See details
The Aetna Medicare Eagle Giveback (PPO) covers partial hospitalization services with a copay of either $60.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services under the Aetna Medicare Eagle Giveback (PPO) are covered with a $285.00 copay per trip for both ground and air transport, requiring prior authorization and featuring no coinsurance. Routine transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Aetna Medicare Eagle Giveback (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum with no coinsurance, requiring a $115 copay for medical care and a $285 copay for emergency transportation.
Primary Care See details
Aetna Medicare Eagle Giveback (PPO) features primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Most other services, including physical, occupational, and mental health therapies, require a $35 to $40 copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Eagle Giveback (PPO) covers preventive services, such as annual physicals and screenings, with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are partially covered, as the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, or counseling.
Hearing Services See details
Aetna Medicare Eagle Giveback (PPO) covers hearing services with no deductible, offering Medicare-covered exams for a $35 copay and no coinsurance, alongside one routine exam and fitting evaluation per year with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,700 for up to two devices per year, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Eagle Giveback (PPO) covers vision services with no deductibles and no coinsurance, offering routine eye exams with no copay and Medicare-covered exams with a $0 to $35 copay. Eyewear is also covered with no copay and no coinsurance, providing up to a $200 combined annual benefit for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle Giveback (PPO), which features a $35 copay and no coinsurance for Medicare-covered dental services, and no copay or coinsurance for other preventive and comprehensive services up to a $1,500 annual maximum. While many dental treatments are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle Giveback (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this plan, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Eagle Giveback (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Eagle Giveback (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle Giveback (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic lab and radiological services have no copay, diagnostic tests range from no copay up to $35 with no coinsurance, while outpatient X-rays require a $35 copay and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Eagle Giveback (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Aetna Medicare Eagle Giveback (PPO), but only some services are covered. Specifically, cardiac rehabilitation (requiring a $20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle Giveback (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Eagle Giveback (PPO) partially covers other services with no copay and no coinsurance, including a $60 quarterly over-the-counter (OTC) allowance, meal benefits for chronic illness, and annual wellness exams. Acupuncture is not covered under this plan.
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