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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 2026, 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 Maricopa, Pima and Pinal Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $110.00. 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 $8950.00 (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 $8950.00 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 medical coverage featuring no copay for primary care doctor visits and a $45 copay for specialist visits. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $50 copay. For inpatient hospital stays, members pay a daily copay of $400 for the first seven days of acute care, followed by no copay for subsequent days. This plan also includes key supplemental benefits to help lower your out-of-pocket healthcare expenses. Members benefit from no copay on routine vision exams, eyewear, preventive dental care, and annual hearing exams. Additionally, the plan provides a $90 allowance every three months for over-the-counter items with no copay, though certain services like cardiac rehabilitation and acupuncture are not covered.
Inpatient Hospital See details
Aetna Medicare Eagle (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $400 daily copay for days 1 to 7 of acute stays and a $370 daily copay for days 1 to 5 of psychiatric stays, followed by no copay. Non-Medicare-covered stays, upgrades for acute care, and additional days for psychiatric care are not covered.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $450, outpatient substance abuse sessions have a $40 copay, and observation services cost a $400 copay per stay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Eagle (PPO) with a copay ranging from $55.00 to $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Eagle (PPO) partially covers ambulance and transportation services, though transportation to plan-approved or any health-related locations is not covered. Ground ambulance services require a $245 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for all ambulance services.
Emergency Services See details
Emergency services are covered by Aetna Medicare Eagle (PPO) with a $130 copay and no coinsurance, and the copayment is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services and transportation are covered up to a $250,000 limit with copays ranging from $130 to $245 and no coinsurance.
Primary Care See details
Primary care benefits are covered by Aetna Medicare Eagle (PPO), featuring no copay or coinsurance for primary care visits, a $45 copay with no coinsurance for specialists, and a 20% coinsurance with a $0 to $50 copay for telehealth. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine chiropractic care which is not covered, while podiatry services are not covered at all.
Preventive Services See details
Aetna Medicare Eagle (PPO) partially covers preventive services, offering no copay and no coinsurance for most options like annual physical exams and fitness benefits, while kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional or dietary benefits, home-based palliative care, in-home support services, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling services.
Hearing Services See details
Aetna Medicare Eagle (PPO) provides partially covered hearing services, featuring no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with a copay ranging from $0 to $1,700 and no coinsurance, but OTC hearing aids and prescription aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Eagle (PPO) with no copay, no deductible, and no coinsurance for eye exams and eyewear. The plan provides up to a $50 annual maximum for eye exams and a combined $250 annual allowance for eyewear, including contacts, lenses, and frames.
Dental Services See details
Aetna Medicare Eagle (PPO) partially covers dental services, offering preventive care like oral exams, cleanings, and x-rays with no copay or coinsurance, and Medicare dental services for a $45 copay. Comprehensive services like restorative care, endodontics, periodontics, prosthodontics, and oral surgery are covered with a 20% to 50% coinsurance up to a $3,000 annual limit, while fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle (PPO) covers home infusion bundled services with prior authorization, though mandatory supplemental Part D home infusion drugs are not covered. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Eagle (PPO) with a 20% coinsurance and no copay. Prior authorization is required for this benefit.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. These covered benefits feature no copays and coinsurance ranging from 0% to 20%, except for diabetic therapeutic shoes and inserts which have no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Eagle (PPO) with prior authorization required. Diagnostic tests and lab services have no coinsurance and a $0 to $10 copay, while radiological services require a $10 copay for X-rays, a $0 to $220 copay for diagnostic radiology (both with no coinsurance), and 20% coinsurance with no copay for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Eagle (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Eagle (PPO) plan, meaning there is no copay or coinsurance coverage available. This non-coverage applies to all related treatments, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, offering no copay or coinsurance for days 1 through 20 and a $218 daily copay with no coinsurance for days 21 through 100. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Aetna Medicare Eagle (PPO) plan, as acupuncture, meal benefits, and Dual Eligible SNPs are not covered. Covered benefits, including annual wellness exams, select screenings, and over-the-counter items up to $90 every three months, are offered with no copay and no coinsurance.
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