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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/Southern Illinois. This plan received an overall rating of 4 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 $8000.00 (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 $8000.00 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 variety of benefits with varying costs. Inpatient hospital stays range from a $260-$395 copay, and outpatient services may have copays between $0-$395. Emergency services have a $125 copay, and primary care, preventive services, vision, and dental services typically have no copay. The plan also covers services like hearing exams, with some copays and coverage for hearing aids, as well as home health services with no copay. Prescription hearing aids are covered up to $1500 per year. Other services, such as ambulance, skilled nursing facility, and other diagnostic services, have varying copays and coinsurance.
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 will pay a $395 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric care has a $260 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Eagle (PPO) plan, including all outpatient hospital services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $395, and observation services have a copay of $395. Outpatient substance abuse services have a $35 copay for individual sessions and a $25 copay for group sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, requiring prior authorization. You will pay a $65 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 $290 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 by the Aetna Medicare Eagle (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $290 copay; all services have no coinsurance.
Primary Care See details
Under the Aetna Medicare Eagle (PPO) plan, Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $35 copay. Mental Health Specialty Services, including individual and group sessions, have a $30 copay. Podiatry Services, including Routine Foot Care, have a $35 copay. Other Health Care Professional services have a copay between $0 and $35. Psychiatric Services, including individual and group sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services include 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 exams have a $30 copay, routine hearing exams have no copay for 1 visit per year, and fitting/evaluation for hearing aids have no copay for 1 visit per year. Prescription hearing aids are covered up to a maximum of $1500 per year, and prescription hearing aids (all types) have no copay for 2 visits per year. The plan does not cover prescription hearing aids for inner ear, outer ear, or over the ear, and does not cover OTC hearing aids.
Vision Services See details
The Aetna Medicare Eagle (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $250 per year.
Dental Services See details
The Aetna Medicare Eagle (PPO) plan covers various dental services, including oral exams, dental X-rays, and other diagnostic services with no copay. Preventative services like cleanings and fluoride treatments also have no copay, and the plan includes a $1,500 maximum benefit per year for both in and out-of-network services. However, some services such as Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. 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 by the Aetna Medicare Eagle (PPO) plan, with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a coinsurance between 0% and 20%, while durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance. Medical supplies have a coinsurance between 0% and 20%. Diabetic therapeutic shoes/inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $75, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $250, Therapeutic Radiological Services with a $60 copay, and Outpatient X-Ray Services with a $20 copay. All services require prior authorization.
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. While the plan covers some cardiac rehabilitation services, specific services like Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Eagle (PPO), but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Under the Aetna Medicare Eagle (PPO) plan, acupuncture, 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, 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. Over-the-counter (OTC) items and meal benefits are covered with no copay. Other services such as annual wellness exams, screening mammography, gFOBT, and FIT are covered with no copay.
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