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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 District of Columbia and Maryland. 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 $50.00. 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 for different services. Inpatient hospital stays have copays, while outpatient services have a mix of copays and no copays depending on the service. Emergency, primary care, and preventive services often have low or no copays, providing accessible care. The plan includes coverage for hearing, vision, and dental services with varying copays and maximum benefits. Additional benefits include coverage for medical equipment, home health services with no copay, and skilled nursing facility stays with copays. The plan also offers an OTC benefit and covers other services such as wellness exams and screenings.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered by the Aetna Medicare Eagle (PPO) plan. For inpatient hospital-acute, you'll pay a copay of $340 for days 1-8, and no copay for days 9-90; for inpatient hospital psychiatric, you'll pay a copay of $286 for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, outpatient blood services with no copay, and ambulatory surgical center (ASC) services with no copay. Observation services have a $340 copay, and outpatient hospital services have a copay between $0 and $340. Outpatient substance abuse services, including individual and group sessions, have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Eagle (PPO) plan, but requires prior authorization. You will have a $105 copay for this benefit.
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 health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Eagle (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Under the Aetna Medicare Eagle (PPO) plan, Primary Care Physician Services have no copay, Chiropractic Services have a $15 copay, Occupational Therapy Services have a $20 copay, Physician Specialist Services have a $35 copay, and Mental Health Specialty Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $20 copay, and Additional Telehealth benefits have a 20% coinsurance with a copay ranging from $0 to $40. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
The Aetna Medicare Eagle (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and some services have a copay; for example, Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit have no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a maximum plan benefit of $1250 per year, and all types of prescription hearing aids are covered with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. 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 no coinsurance, and eyewear with no copay or coinsurance, up to a combined maximum of $200 per year for both in-network and out-of-network services. Routine eye exams are covered with no copay, once per year, and other eye exam services are covered with no copay.
Dental Services See details
Dental services include a $35 copay for Medicare dental services and no copay for 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, with a $2,000 maximum benefit per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Eagle (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 (PPO) plan, but prior authorization is required. You will pay a 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Eagle (PPO) plan, with Durable Medical Equipment (DME) subject to a 0-20% coinsurance and requiring prior authorization. Prosthetic devices have a 20% coinsurance, while medical supplies have a 0-20% coinsurance; diabetic supplies have a 0-20% coinsurance, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Eagle (PPO) plan, with all diagnostic services requiring prior authorization, and lab services with no copay. Diagnostic Procedures/Tests have a copay between $0 and $95, while Diagnostic Radiological Services have a copay up to $200, and Therapeutic Radiological Services have a coinsurance of at least 20%.
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
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Eagle (PPO) plan. This plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
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 and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Eagle (PPO) plan covers Over-the-Counter (OTC) items with no copay and a maximum plan benefit of $30 every three months, but does not cover 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. The plan also covers a meal benefit with no copay, and other services including annual wellness exams and screening mammography, and gFOBT and FIT with no copay.
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