A non-government entity
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 Washington. 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 $60.00. 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:
Sign up for Aetna Medicare Eagle (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Aetna Medicare Eagle (PPO).
Additional Benefits
The Aetna Medicare Eagle (PPO) plan offers robust medical coverage with no copay for primary care visits, while specialist visits range from no copay to a $35 copay. Inpatient hospital stays require a $425 daily copay for the first five days and no copay for days six through 90, with no coinsurance. Outpatient services feature no coinsurance and no copays for ambulatory surgical centers, though hospital outpatient visits can range up to a $350 copay. For supplemental care, members benefit from no copays, coinsurance, or deductibles on routine vision exams, eyewear up to $300 annually, and hearing services including up to two prescription hearing aids. Preventive dental care features no copay, while comprehensive dental is covered with coinsurance up to a $1,750 annual limit. Additionally, the plan covers home health and lab services with no copay, alongside an over-the-counter allowance of $75 every three months.
Inpatient Hospital See details
Aetna Medicare Eagle (PPO) covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. While unlimited additional acute care days are covered with no copay, this plan does not cover additional psychiatric days, room upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services. Copays apply to other outpatient treatments, including a $40 copay for substance abuse sessions, $425 per stay for observation services, and $0 to $350 for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Eagle (PPO) with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Eagle (PPO) covers ground ambulance services with a $265 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services are not covered, meaning trips to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Eagle (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care services with a $35 copay and no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay, and worldwide emergency transportation has a $265 copay, both with no coinsurance and subject to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Eagle (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapy services require a $25 copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Aetna Medicare Eagle (PPO) plan, featuring no copay and no coinsurance for annual physical exams, health education, and fitness benefits, though kidney disease education requires a 20% coinsurance with no copay. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services.
Hearing Services See details
Aetna Medicare Eagle (PPO) provides partially covered hearing services with no copay, no coinsurance, and no deductible for annual routine exams, fitting evaluations, and up to two prescription hearing aids per year with a $1,250 maximum coverage limit per ear. However, over-the-counter (OTC) hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Vision services are covered under the Aetna Medicare Eagle (PPO) with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. The plan provides up to $50 annually for eye exams, including one routine exam, and a $300 yearly allowance for eyewear like contacts, lenses, and frames.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle (PPO), with Medicare-covered services requiring a $35 copay and no coinsurance, while preventive care like cleanings and exams has no copay and no coinsurance. Comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $1,750 annual limit, but fluoride, implants, orthodontics, other diagnostic or preventive services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle (PPO) covers home infusion bundled services with no copay, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Eagle (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays and coinsurance ranging from 0% to 20%. Prior authorization is required for these benefits, which also include diabetic therapeutic shoes and inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Eagle (PPO) with no copay and no coinsurance for lab services and diagnostic procedures. Outpatient X-rays and diagnostic radiological services require no copay, while therapeutic radiological services carry a minimum 20% coinsurance. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home health services are covered under the Aetna Medicare Eagle (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Aetna Medicare Eagle (PPO) plan, as there is no coverage, copay, or coinsurance for standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $210 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Aetna Medicare Eagle (PPO) partially covers other services, providing no copay and no coinsurance for annual wellness exams, screening mammographies, additional colorectal screenings, and over-the-counter items up to $75 every three months. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved