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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 Central FL. 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 $70.00. 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 $10100.00 (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 $10100.00 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 range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care, preventive services, and many vision and dental services. The plan also covers ambulance services, emergency services, and home health services, and offers other benefits such as home infusion bundled services. This plan provides coverage for hearing services, but excludes OTC hearing aids, and has a $1,000 annual maximum for dental services. However, it's important to note that some services, like certain cardiac rehabilitation services and private duty nursing, are not covered. Additionally, this plan may require prior authorization for some services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you also pay a $250 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while additional days and non-Medicare stays for Inpatient Hospital Psychiatric are not covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient hospital services, including observation services, are covered with copays ranging from $0 to $250 per visit. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (PPO) plan, including all ambulance services and transportation services to plan-approved health-related locations. Ground ambulance services have a $250 copay, while air ambulance services have 20% coinsurance; transportation services have no copay. 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a $250 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care services with no copay. Chiropractic services have a $20 copay, while occupational therapy has a $40 copay. Specialist services have a copay between $0 and $40, and physical therapy and speech-language pathology services have a $40 copay. Mental health and psychiatric services have a $30 copay. Additional telehealth services have a 20% coinsurance and a copay between $0 and $40. Other health care professionals have a copay between $0 and $40, and opioid treatment program services have a $30 copay. Routine Chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services including an annual physical exam with no copay, and other services that may have a copay. The plan covers Kidney Disease Education Services with a 20% coinsurance, and other preventive services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services are covered by the Aetna Medicare Eagle (PPO) plan. Hearing exams have a $40 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $40, and eyewear with no copay. Routine eye exams are covered with no copay for one visit every year, and other eye exam services are covered with no copay. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, and a combined maximum of $200 per year.
Dental Services See details
The Aetna Medicare Eagle (PPO) plan covers a variety of dental services, including oral exams, x-rays, and other diagnostic and preventive services with no copay, and a $1,000 annual maximum. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Eagle (PPO) plan. You will pay 20% coinsurance for this service, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment with varying coinsurance and copays. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $75, and lab services with no copay. Radiological Services are covered, including diagnostic radiological services with a copay up to $200 and therapeutic radiological services with a coinsurance of at most 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Eagle (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Eagle (PPO) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, these services are not covered.
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, but for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Eagle (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits 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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