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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 Tennessee. 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 $30.00. 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 $7750.00 (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 $7750.00 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 comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have copays, while outpatient services often have copays ranging from $0 to $374. Emergency services and primary care visits often feature no copay, while specialist visits may have a copay between $0 and $35. Preventive services, including an annual physical, come with no copay, as do many vision and dental services. The plan also covers hearing exams, hearing aids, and home health services. Other services such as ambulance, skilled nursing facilities, and dialysis services have their own cost structures, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $374 copay for days 1-8, and no copay for days 9-90; for Inpatient Hospital Psychiatric, the copay is $286 for days 1-8, and no copay for days 9-90.
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 $374, observation services with a $374 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, but requires prior authorization. You will have a $105 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 $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location 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, while Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $275 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, occupational therapy services with a $30 copay, physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit have a $0 copay. The plan also covers Kidney Disease Education Services with 20% coinsurance.
Hearing Services See details
Hearing Services includes coverage for Hearing Exams with a $35 copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids are covered up to a maximum of $1250 per year, while Prescription Hearing Aids - 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 covers vision services, including eye exams with a copay of $0-$35, and routine eye exams with no copay. Eyewear is covered with no copay, and a combined maximum benefit of $200 every year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, along with other services like Oral Exams, Dental X-Rays, and more with no copay, with a maximum plan benefit of $2,000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
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. Medicare Part B Insulin Drugs have a $35 copay.
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 these services.
Medical Equipment See details
Medical equipment benefits are covered by the Aetna Medicare Eagle (PPO) plan, with no copay for Durable Medical Equipment and Prosthetics/Medical Supplies. Durable Medical Equipment has a coinsurance between 0% and 20%, while Medical Supplies have a coinsurance between 0% and 20% and Prosthetic Devices have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $14 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
Aetna Medicare Eagle (PPO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The plan has a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific copay amount is not provided.
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, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items and a meal benefit with no copay, as well as annual wellness exams, screenings, and other services with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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.
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