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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 California. 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 $65.00. 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 $9500.00 (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 $9500.00 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 coverage with no copay for primary care visits, home health services, and routine preventive care. For specialized medical needs, members pay a $40 copay for specialist visits, while emergency room visits require a $130 copay, which is waived if admitted. Inpatient hospital stays cost a $430 daily copay for the first four days, with no copay for days five through ninety. This plan also includes valuable supplemental benefits, such as no copay for routine vision and hearing exams, featuring a $500 annual eyewear allowance and a $1,500 annual prescription hearing aid allowance. Dental care is covered with no copay for preventive services and a twenty to fifty percent coinsurance for comprehensive procedures up to a $3,000 annual limit. Additionally, members receive a $75 quarterly reimbursement for over-the-counter items and pay no copay for diagnostic lab work and outpatient X-rays.
Inpatient Hospital See details
Aetna Medicare Eagle (PPO) provides partially covered inpatient acute and psychiatric hospital services, requiring a $430 daily copay for days 1 through 4, and no copay or coinsurance for days 5 through 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Copays range from no copay to $350 for outpatient hospital services, while observation services cost a $430 copay per stay and outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Aetna Medicare Eagle (PPO) covers partial hospitalization benefits with a copay of either $60.00 or $145.00 and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Eagle (PPO), as transportation services to health-related locations are not covered. Ground ambulance services require a $265 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
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 services require a $40 copay and no coinsurance, while worldwide emergency and urgent care are covered up to $250,000 with copays ranging from $130 to $265.
Primary Care See details
Aetna Medicare Eagle (PPO) offers partially covered primary care benefits with no copay and no coinsurance for primary care visits, while podiatry and routine chiropractic services are not covered. Covered specialist and psychiatric services require a $40 copay, physical and occupational therapies require a $20 copay, and telehealth services require no copay to a $40 copay and 20% coinsurance, with no coinsurance for other in-person visits.
Preventive Services See details
Aetna Medicare Eagle (PPO) partially covers preventive services, offering most covered benefits like annual physical exams and health education with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services 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 and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle (PPO), which offers annual routine hearing exams and evaluations with no copay or coinsurance. While the plan provides up to $1,500 annually for covered prescription hearing aids with no copay or coinsurance, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Eagle (PPO) with no copay and no coinsurance for both eye exams and eyewear. Members receive up to a $50 annual maximum for eye exams and a $500 annual combined limit for eyewear, which covers contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle (PPO), offering Medicare-covered dental with a $40 copay and no coinsurance, alongside preventive exams, cleanings, and x-rays with no copay or coinsurance. Comprehensive services like restorative care and periodontics require 20% to 50% coinsurance and no copay up to a $3,000 annual limit, while fluoride, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle (PPO) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation therapies, require no copay and a coinsurance ranging from no coinsurance up to 20 percent.
Dialysis Services See details
Aetna Medicare Eagle (PPO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment, prosthetics, and diabetic supplies are covered by Aetna Medicare Eagle (PPO) with no copays. Depending on the item, coinsurance ranges from no coinsurance up to 17% for durable medical equipment and medical supplies, 17% for prosthetic devices, and up to 20% for diabetic supplies.
Diagnostic and Radiological Services See details
Aetna Medicare Eagle (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have a copay of up to $10 and no coinsurance, while lab services and outpatient X-rays have no copay and no coinsurance. Diagnostic radiological services have a copay of up to $150 and no coinsurance, whereas therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Aetna Medicare Eagle (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Eagle (PPO) plan, including intensive cardiac, pulmonary, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond Medicare-covered services are not covered.
Other Services See details
Aetna Medicare Eagle (PPO) covers several additional benefits with no copay and no coinsurance, including a $75 quarterly reimbursement for over-the-counter items, annual wellness exams, and additional colorectal cancer screenings. Acupuncture, meal benefits, and Dual Eligible SNPs with highly integrated services are not covered.
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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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