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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 N FL, S FL, Treasure Coast FL, Panhandle/NW FL. 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. Additionally, this plan comes with a Part B Premium reduction of $70.00. 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:
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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 variety of benefits with varying costs. Inpatient hospital stays have a $250 copay for the first 7 days, with no copay for the remainder, and outpatient services have copays between $0 and $250. Emergency services have a $125 copay, and primary care visits have no copay. Preventive services, such as the annual physical exam, are covered with no copay, and vision and dental services are also covered with no copay for many services. Hearing exams have a $40 copay, and hearing aids are partially covered. The plan also covers ambulance services, home health services, and medical equipment, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric services. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $250 copay for days 1-7, and no copay for days 8-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient services with the Aetna Medicare Eagle (PPO) plan cover all outpatient hospital services, with a copay between $0 and $250, and observation services with a $250 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Eagle (PPO) plan. Ground ambulance services have a $250 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered, with no copay, up to 12 one-way trips per year using rideshare services, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Eagle (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay while Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care physician services with no copay, and covers chiropractic services with a $20 copay for routine care. Occupational therapy services have a $40 copay, while physician specialist services have a $0-$40 copay, and physical therapy and speech-language pathology services have a $40 copay. Mental health and psychiatric services, individual sessions, and group sessions all have a $30 copay. Other health care professional services have a $0-$40 copay. Additional telehealth benefits have a 20% coinsurance and a $0-$40 copay. Opioid treatment program services have a $30 copay. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services with no copay for the annual physical exam, and also covers Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered, each with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for a hearing aid with no copay. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types of hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $40, routine eye exams with no copay, and other eye exam services with no copay. Eyewear is covered with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum of $200 per year.
Dental Services See details
Dental services under the Aetna Medicare Eagle (PPO) plan include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics. There is a $40 copay for Medicare Dental Services, and the plan has a $1,000 annual maximum benefit for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered, though prior authorization is required. 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 by the Aetna Medicare Eagle (PPO) plan, and require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Eagle (PPO) plan, including Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetics/Medical Supplies with a coinsurance of 0-20%, and Diabetic Equipment with a coinsurance of 0-20% and a $10 copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have 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. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services 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, there is a $214 copay.
Other Services See details
Aetna Medicare Eagle (PPO) covers Over-the-Counter (OTC) items and meal benefits with no copay, as well as other services with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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