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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 Utah. 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 $75.00. 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 provides robust medical coverage with no copays or coinsurance for primary care physician visits, home health services, and annual preventive exams. Specialist visits range from no copay to a $40 copay, while outpatient hospital services range from no copay to a $400 copay, both with no coinsurance. For inpatient hospital care, members pay no coinsurance and a daily copay of $475 for acute stays or $370 for psychiatric stays for the first five days, with no copay required for subsequent days. Supplemental care is highly accessible, featuring routine hearing and eye exams with no copay, no deductible, and no coinsurance. Preventive dental services require no copay, while comprehensive dental is covered up to $2,500 annually with 20% to 50% coinsurance and no copay. Additionally, the plan covers up to two prescription hearing aids per year with no coinsurance and a copay ranging from no copay to $1,700, alongside a $75 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Eagle (PPO) with no coinsurance, requiring prior authorization and a daily copay of $475 for days 1 through 5 of acute stays (no copay thereafter) or $370 for days 1 through 5 of psychiatric stays (no copay for days 6 through 90). Non-Medicare-covered stays, acute upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services carry a $0 to $400 copay, observation services require a $475 copay per stay, and outpatient substance abuse sessions have a $40 copay, with prior authorization required for most of these benefits.
Partial Hospitalization See details
Partial hospitalization services are covered by the Aetna Medicare Eagle (PPO) plan with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Eagle (PPO) with a $265 copay for ground ambulance and 20% coinsurance for air ambulance, with prior authorization required. Transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Eagle (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with a $130 copay (and a $265 copay for worldwide emergency transportation) and no coinsurance, up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Eagle (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits feature a copay ranging from $0 to $40 and no coinsurance. Physical, occupational, and speech therapy services require a $20 copay and no coinsurance, but podiatry and routine chiropractic services are not covered. Mental health and psychiatric services are covered with a $40 copay and no coinsurance, subject to prior authorization.
Preventive Services See details
Aetna Medicare Eagle (PPO) offers partially covered preventive services with no copay and no coinsurance for annual exams, fitness benefits, and screenings, while kidney disease education requires a 20% coinsurance and no copay. Supplemental services not covered under this benefit include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle (PPO), offering routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered for up to two devices per year with no coinsurance and a copay ranging from $0 to $1,700, but over-the-counter (OTC) hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Eagle (PPO) offers vision services with no deductible, no copay, and no coinsurance for covered eye exams and eyewear. This benefit includes one routine eye exam per year with a $50 annual maximum, and a $300 combined annual maximum for eyewear, including contact lenses and eyeglasses.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle (PPO), offering Medicare-covered dental for a $40 copay and no coinsurance, and preventive services like cleanings and exams for no copay and no coinsurance. Comprehensive dental care is covered up to a $2,500 yearly maximum with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Eagle (PPO) with no copay, requiring prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Eagle (PPO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic lab services with no copay and diagnostic tests with a $0 to $10 copay, both with no coinsurance. Radiological services include outpatient X-rays for a $10 copay plus coinsurance, diagnostic radiology starting with no copay, and therapeutic radiology requiring a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Eagle (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Eagle (PPO) with no coinsurance. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $20 copay, while pulmonary rehabilitation is not covered and requires a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Eagle (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required before admission, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Aetna Medicare Eagle (PPO) partially covers other services, offering over-the-counter (OTC) items up to $75 every three months, an annual wellness exam and screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture and meal benefits are not covered.
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