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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 Colorado. 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 $80.00. 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 healthcare coverage with predictable costs, featuring no copay for primary care visits and a $40 copay for specialists. If you require hospital care, inpatient stays carry a $325 daily copay for the first six days and no copay thereafter, while outpatient services range from no copay up to a $325 copay. Emergency room visits require a $130 copay, which is waived if you are admitted, and urgent care is available for a $50 copay. This plan also includes strong auxiliary benefits, providing routine dental, vision, and hearing exams with no copays. You will receive a $200 annual allowance for eyewear, up to $1,250 per ear yearly for prescription hearing aids, and a ninety-dollar quarterly allowance for over-the-counter items. Most preventive services, home health visits, and lab tests are also covered with no copay or coinsurance, helping you manage your wellness affordably.
Inpatient Hospital See details
Aetna Medicare Eagle (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $325 copay for days 1 through 6 and no copay for days 7 and beyond. Inpatient psychiatric care is also covered with no coinsurance, featuring a $370 copay for days 1 through 5 and no copay for days 6 through 90, though 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 of $0 to $325 for outpatient hospital services and $325 per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Aetna Medicare Eagle (PPO) plan with a copayment 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) partially covers Ambulance and Transportation Services, which require prior authorization for ambulance transport. Ground ambulance services incur a $290 copay plus coinsurance, air ambulance services require a 20% coinsurance plus a copay, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Eagle (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care with a $50 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $250,000 maximum limit with no coinsurance, featuring a $130 copay for emergency or urgent care and a $290 copay for emergency transportation.
Primary Care See details
Aetna Medicare Eagle (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, mental health, and psychiatric services require a $40 copay and no coinsurance. Podiatry is not covered, telehealth services require a $0 to $50 copay and 20% coinsurance, and some chiropractic services are covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Eagle (PPO), offering no copay and no coinsurance for annual physical exams, health education, and screenings, while kidney disease education requires no copay and a 20% coinsurance. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Eagle (PPO), offering Medicare-covered exams, routine exams, and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered up to $1,250 per ear yearly with no copay or coinsurance, but OTC hearing aids and prescription inner ear, outer ear, and over-the-ear 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. This benefit includes a $50 annual maximum for one routine eye exam per year and a $200 combined annual maximum allowance for eyewear, including contact lenses, eyeglasses, and upgrades.
Dental Services See details
Dental services covered by Aetna Medicare Eagle (PPO) include Medicare-covered dental care for a $40 copay and no coinsurance, alongside routine cleanings, exams, and X-rays with no copay and no coinsurance. Comprehensive services like restorative care and oral surgery are covered up to a $2,000 annual limit with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay with no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs have 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, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Eagle (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copays and prior authorization required. Depending on the item, your cost-sharing will range from no coinsurance up to 20% coinsurance, with diabetic supplies limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Eagle (PPO) with prior authorization, featuring no coinsurance for diagnostic services, no copay for lab services, and a $0 to $20 copay for diagnostic tests. Radiological services include outpatient X-rays for a $10 copay, diagnostic radiology with copays starting at $0, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Eagle (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Eagle (PPO) covers cardiac rehabilitation services with no coinsurance, though copayments apply for specific treatments. Patients will pay a $20 copay for cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement. Prior authorization is required, featuring no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coverage for additional days beyond the standard Medicare limit.
Other Services See details
Other services under the Aetna Medicare Eagle (PPO) are partially covered with no copay and no coinsurance, offering benefits such as chronic illness meals, wellness exams, and a ninety-dollar quarterly over-the-counter allowance. Acupuncture is not covered under this plan.
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