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Aetna Medicare Eagle 1 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Eagle 1 (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 1 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Eagle 1 (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 2025.
It's important to know that Aetna Medicare Eagle 1 (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 1 (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 1 (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 $75.00. 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 $8950.00 (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 $8950.00 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 1 (PPO).
Additional Benefits
The Aetna Medicare Eagle 1 (PPO) plan offers comprehensive coverage with a variety of benefits. This plan provides coverage for inpatient hospital stays, with copays ranging from $0 to $370, and outpatient services with copays varying from $0 to $325. You'll also find coverage for services like emergency care, primary care with no copay for many services, vision, dental, and home health services with no copay, as well as hearing services with no copay for exams and fittings. Additional benefits include coverage for ambulance services with copays, partial hospitalization with a $55 copay, and services like durable medical equipment and diagnostic services with coinsurance or copays. The plan also includes coverage for home infusion services, skilled nursing facility stays with copays, and other services like over-the-counter items and a meal benefit with no copay. Prior authorization is required for some services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you'll pay a $370 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital Psychiatric, Non-Medicare-covered stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the Aetna Medicare Eagle 1 (PPO) plan. The plan has a copay of $0-$325 for outpatient hospital services, $325 for observation services, and no copay for ambulatory surgical center services and outpatient blood services. Individual and group sessions for outpatient substance abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Eagle 1 (PPO) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle 1 (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance, and 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 1 (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $290 copay for Worldwide Emergency Transportation, with a maximum benefit coverage of $150,000.
Primary Care See details
The Aetna Medicare Eagle 1 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay for routine care, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay, other health care professional services with a copay ranging from $0 to $40, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $50, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Eagle 1 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay, while prescription hearing aids have a maximum plan benefit coverage of $1250 per year. Prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Eagle 1 (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. The plan includes a combined maximum of $200 per year for eyewear.
Dental Services See details
The Aetna Medicare Eagle 1 (PPO) plan covers Medicare Dental Services with a $40 copay and other dental services with a $2,200 maximum per year. 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Eagle 1 (PPO) plan and require prior authorization. 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 under the Aetna Medicare Eagle 1 (PPO) plan, but require prior authorization. You will be responsible for 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Eagle 1 (PPO) plan, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20% and Prosthetics/Medical Supplies with a coinsurance. Diabetic Equipment is covered, with a coinsurance of 0% to 20% for Diabetic Supplies and a 20% coinsurance for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $150, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Eagle 1 (PPO) 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 not covered by the Aetna Medicare Eagle 1 (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
The Aetna Medicare Eagle 1 (PPO) plan covers Skilled Nursing Facility (SNF) services, with a $0 copay for days 1-20 and a $214 copay for days 21-100, but does not cover additional days beyond Medicare-covered, or non-Medicare-covered SNF stays. Prior authorization is required.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items and a meal benefit with no copay, and Other 1 and Other 2 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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