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Aetna Medicare Eagle Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle Plus (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 Plus (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Eagle Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties Across MS. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Eagle Plus (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 Plus (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 Plus (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 $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:
Sign up for Aetna Medicare Eagle Plus (PPO)
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Drug Coverage
Prescription drugs are not covered by Aetna Medicare Eagle Plus (PPO).
Additional Benefits
The Aetna Medicare Eagle Plus (PPO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a copay of up to $35, while emergency room visits carry a $115 copay that is waived if you are admitted. For hospital stays, members pay a daily copay of $380 for days 1 to 7 of acute inpatient care with no coinsurance. This plan also provides comprehensive auxiliary benefits, including no copay for routine vision and hearing exams, plus allowances for eyewear and hearing aids. Preventive dental care features no copay, while comprehensive dental services are covered with a 20% to 50% coinsurance up to a $4,000 annual limit. Additionally, members benefit from a $150 quarterly over-the-counter item allowance and pay a 20% coinsurance for durable medical equipment with no copay.
Inpatient Hospital See details
Aetna Medicare Eagle Plus (PPO) covers inpatient hospital services with no coinsurance, requiring a $380 daily copay for days 1 to 7 of acute stays and a $407 daily copay for days 1 to 5 of psychiatric stays. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle Plus (PPO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services require copays ranging from $0 to $380, while outpatient substance abuse individual and group sessions carry a $25 copay.
Partial Hospitalization See details
Aetna Medicare Eagle Plus (PPO) covers partial hospitalization services with a copayment of either $105.00 or $110.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Eagle Plus (PPO) covers ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Eagle Plus (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays of $115 for emergency or urgent care and $295 for emergency transportation.
Primary Care See details
Aetna Medicare Eagle Plus (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a copay of up to $35 and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with a $25 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Eagle Plus (PPO) offers preventive services with no copay and no coinsurance for annual physicals, health education, fitness, and screenings, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are partially covered, excluding 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, home-based palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services under the Aetna Medicare Eagle Plus (PPO) are partially covered, featuring a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to $500 per ear annually, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Eagle Plus (PPO) covers vision services with no deductibles and no coinsurance, featuring no copay for routine eye exams and up to a $35 copay for Medicare-covered exams. Covered eyewear, including lenses, frames, and contacts, has no copay up to a combined $350 annual maximum benefit.
Dental Services See details
Aetna Medicare Eagle Plus (PPO) partially covers dental services, excluding fluoride treatments, implant services, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services. Medicare-covered dental has a $35 copay and no coinsurance, while covered preventive care has no copay or coinsurance, and covered comprehensive services have no copay and 20% to 50% coinsurance up to a $4,000 annual limit.
Home Infusion bundled Services See details
Aetna Medicare Eagle Plus (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Eagle Plus (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Eagle Plus (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with no copays. Members are responsible for a 20% coinsurance on DME, prosthetics, and medical supplies, while diabetic supplies require between no coinsurance and 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle Plus (PPO) covers diagnostic and radiological services, subject to prior authorization. Lab services and outpatient X-rays feature no copay, diagnostic tests have a copay of $0 to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Eagle Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Eagle Plus (PPO), though some services are not covered. Covered standard and intensive cardiac rehabilitation require a $25 copay with no coinsurance, pulmonary rehabilitation carries a 20% coinsurance with no copay, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) has a $20 copay with no coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle Plus (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Eagle Plus (PPO) partially covers other services with no copay and no coinsurance, including a $150 quarterly over-the-counter item allowance, chronic illness meal benefits, and annual wellness exams. Acupuncture is not covered under this plan.
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