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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 Nevada. 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 $115.00. 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 a wide range of benefits with varying cost-sharing. Inpatient hospital stays have copays depending on the type of stay, while outpatient services have copays that vary by service. Emergency and urgent care services have copays, and primary care visits have no copay. Preventive services like annual physicals are covered with no copay. Hearing services include hearing exams and hearing aids with no copay, and vision services cover eye exams and eyewear with no copay. Dental services, including oral exams and cleaning, have no copay, but there is a $2,500 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $360 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. Additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Eagle (PPO) plan, including outpatient hospital services with a copay between $0 and $350, observation services with a $360 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, and requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (PPO) plan. Ground Ambulance Services have a $265 copay, while Air Ambulance Services have a 20% coinsurance; however, Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Eagle (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Urgent Coverage has a $125 copay, Worldwide Emergency Transportation has a $265 copay, and Urgently Needed Services has a $40 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay (routine care not covered), occupational therapy services with a $20 copay, and physician specialist services with a $0 - $35 copay. Mental health specialty and psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $20 copay, and additional telehealth benefits have a 20% coinsurance and a $0 - $40 copay. Opioid treatment program services have a $40 copay.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Wigs for Hair Loss Related to Chemotherapy, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a maximum copay of $1700, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Eagle (PPO) plan offers vision services including eye exams and eyewear. Eye exams and eyewear have no copay, and there is a $300 combined maximum plan benefit for eyewear every year.
Dental Services See details
The Aetna Medicare Eagle (PPO) plan covers a range of dental services with a $2,500 annual maximum, including 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. Orthodontic services are covered under Diagnostic and Preventive Dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Eagle (PPO) plan, with prior authorization 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, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Aetna Medicare Eagle (PPO) plan. Durable medical equipment has a coinsurance of 0-20%, while durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance. Medical supplies have a coinsurance of 0-20%, and diabetic supplies have a coinsurance of 0-20% with no copay, while diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $10, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Radiological Services have a copay up to $150, and Therapeutic Radiological Services have a coinsurance of at least 20%.
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 covered by the Aetna Medicare Eagle (PPO) plan, but the specific services are not covered. The plan has a copay for some services, but the exact amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits 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, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Aetna Medicare Eagle (PPO) plan, acupuncture, meal benefits, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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, and Self-Directed Personal Assistance Services are not covered. Over-the-counter items and "Other 1" and "Other 2" services are covered with no copay.
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