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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 Oregon. 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 $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 $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 (PPO).
Additional Benefits
The Aetna Medicare Eagle (PPO) plan offers affordable healthcare coverage with no copay for primary care doctor visits and low copays ranging from $0 to $35 for specialists. For hospital stays, members pay no coinsurance, though inpatient services require a $430 daily copay for the first five days and no copay for days six through 90. Outpatient services are also highly accessible, featuring no coinsurance and copays that range from no copay up to $400. This plan provides strong support for essential wellness services, offering routine hearing and vision exams with no copays, no coinsurance, and no deductibles. Preventive dental care is covered with no copay, while comprehensive dental services require no copay and a 20% to 50% coinsurance up to a $1,500 annual limit. Additionally, members benefit from a quarterly $75 over-the-counter item allowance and home health services with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Eagle (PPO) covers inpatient hospital services with no coinsurance, requiring a $430 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional days are covered for acute care, additional psychiatric days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Aetna Medicare Eagle (PPO) covers outpatient hospital services with no coinsurance and a copay ranging from no copay to $400, alongside observation services with no coinsurance and a $430 copay per stay. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions carry a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Eagle (PPO) covers partial hospitalization services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Eagle (PPO), with ground ambulance services requiring a $265 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and while some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Eagle (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $35 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum benefit with no coinsurance and copays ranging from $130 to $265.
Primary Care See details
Aetna Medicare Eagle (PPO) offers primary care doctor visits with no copay and no coinsurance, and specialist services with a $0 to $35 copay and no coinsurance. Therapy services require a $35 copay and no coinsurance, while podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Aetna Medicare Eagle (PPO) preventive services are partially covered, offering no copay and no coinsurance for annual physicals, health education, and screenings, while kidney disease education has no copay and a 20% coinsurance. Sub-services not covered 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
Aetna Medicare Eagle (PPO) covers hearing services with no deductible, no copay, and no coinsurance for routine exams, fittings, and prescription hearing aids. Hearing aids are partially covered with a maximum annual benefit of $1,250 per ear, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Eagle (PPO) with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. The plan features up to a $50 annual maximum for eye exams and a $225 yearly combined maximum for eyewear, including contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Eagle (PPO), offering Medicare-covered dental for a $35 copay and no coinsurance, and exams, cleanings, and x-rays for no copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $1,500 annual limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Eagle (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Eagle (PPO) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical Equipment covered by the Aetna Medicare Eagle (PPO) plan includes durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies range from no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Eagle (PPO) plan, though prior authorization is required. There is no copay and no coinsurance for lab services, diagnostic tests, and diagnostic radiology, while outpatient X-rays have no copay but require coinsurance, and therapeutic radiology carries a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Eagle (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Eagle (PPO) plan, as all individual sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Eagle (PPO) 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, a prior 3-day hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Eagle (PPO) partially covers other services with no copay and no coinsurance, including up to $75 every three months for over-the-counter items, annual wellness exams, and additional colorectal screenings. Acupuncture and meal benefits 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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