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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 Select MS Counties. 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $14000.00 (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 $14000.00 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. For inpatient hospital stays, you'll encounter a copay, while outpatient services have copays ranging from $0-$380. Emergency services and urgent care have copays, and you'll find no copays for primary care visits and many preventive services. The plan includes coverage for hearing, vision, and dental services, with copays and maximum annual benefits. It also covers home health services with no copay, and offers additional benefits like over-the-counter items and meal benefits. However, it's important to note that some services, such as cardiac rehabilitation and additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $380 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you pay a $407 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute, and all sub-services for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $380, and observation services with a $380 copay. Ambulatory Surgical Center (ASC) services and outpatient blood services have no copay, while outpatient substance abuse services have a $25 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan. This benefit has a copay of $80.00.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (PPO) plan. Ground Ambulance Services have a $295 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 under the Aetna Medicare Eagle (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $20 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $295 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, and physician specialist services with a $0-$35 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $25-$30 copay. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a 20% coinsurance and a $0-$35 copay. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services including an annual physical exam with no copay, and additional preventive services, some of which may have a copay. Kidney Disease Education Services are covered with a 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $500 per year, and prescription hearing aids (all types) have no copay. OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $35, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $350 per year.
Dental Services See details
Aetna Medicare Eagle (PPO) covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $3,000 per year for both in-network and out-of-network services. Medicare dental services have a $35 copay and require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Eagle (PPO) plan. 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, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Prosthetics/Medical Supplies and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 0-20% coinsurance 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 $95, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay of at most $300 and therapeutic radiological services with at least 20% coinsurance, and outpatient X-ray services with no 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. While the plan generally covers Cardiac Rehabilitation Services, it does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Additional Cardiac Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
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, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Eagle (PPO) plan's "Other Services" benefit covers over-the-counter items with no copay, up to $150 every three months, and meal benefits with no copay. However, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services are not covered.
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