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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 Clark, Nye and Washoe 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 $130.00. 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 $10000.00 (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 $10000.00 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 robust medical coverage featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits are highly affordable, requiring either no copay or a copay of up to $35, while emergency room care carries a $130 copay that is waived upon hospital admission. For hospital stays, there is no coinsurance, though inpatient acute care requires a $400 daily copay for the first five days of your stay. This plan also provides valuable supplemental benefits, including no-copay routine vision and hearing exams, a $300 annual allowance for eyewear, and prescription hearing aid coverage with copays starting at no copay. Preventive dental care features no copay, while comprehensive dental services are covered up to a $2,500 yearly limit with 20% to 50% coinsurance. Additionally, members enjoy no copays on medical equipment and receive up to $75 every three months in reimbursement for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Eagle (PPO) covers inpatient hospital services with no coinsurance, requiring a $400 daily copay for days 1 to 5 of acute stays and a $370 daily copay for days 1 to 5 of psychiatric stays, with no copay for later days. While unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient services with no coinsurance, featuring a copay ranging from $0 to $425 for outpatient hospital services and a $400 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay, while outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Aetna Medicare Eagle (PPO) covers partial hospitalization services 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
Aetna Medicare Eagle (PPO) covers ambulance services with prior authorization, requiring a $265 copay and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Eagle (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care requires a $40 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 limit with copays ranging from $130 to $265 and no coinsurance.
Primary Care See details
Aetna Medicare Eagle (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, while podiatry is not covered, and chiropractic benefits cover some services but routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Eagle (PPO) with no copay and no coinsurance for annual physical exams, glaucoma screenings, and select fitness benefits, while kidney education services require a 20% coinsurance with no copay. Several supplemental benefits, including in-home safety assessments, medical nutrition therapy, and weight management programs, are not covered.
Hearing Services See details
Aetna Medicare Eagle (PPO) partially covers hearing services, offering Medicare-covered exams, one routine hearing exam, and one fitting evaluation annually with no copay, no coinsurance, and no deductible. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $0 to $1,700, while inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Eagle (PPO) with no copay, no coinsurance, and no deductible for both eye exams and eyewear. The plan includes one routine eye exam per year with a $50 annual maximum coverage limit, and offers a $300 annual combined maximum allowance for contacts, eyeglasses, lenses, and frames.
Dental Services See details
Aetna Medicare Eagle (PPO) dental services are partially covered, offering preventive care like cleanings and exams with no copay and no coinsurance, and Medicare-covered dental with a $35 copay and no coinsurance. Comprehensive dental services have no copay and 20% to 50% coinsurance up to a $2,500 yearly limit, but 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, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Eagle (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment—including durable medical equipment, prosthetics, medical supplies, and diabetic services—with no copays. Coinsurance for these covered items ranges from no coinsurance up to 20%, and prior authorization is required for certain equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Aetna Medicare Eagle (PPO) plan, with prior authorization required. Diagnostic tests and lab services feature no coinsurance and copays ranging from $0 to $10, while radiological services involve copays and coinsurance, including a minimum 20% coinsurance for therapeutic services and no copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Eagle (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Eagle (PPO) partially covers cardiac rehabilitation services with no coinsurance. Standard cardiac, intensive cardiac, and SET for PAD services 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
Aetna Medicare Eagle (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Eagle (PPO) partially covers other services with no copays and no coinsurance, though acupuncture and meal benefits are not covered. Covered benefits include annual wellness exams, additional colorectal screenings, and up to $75 every three months in reimbursement for over-the-counter items.
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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.
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