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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 Oregon. This plan received an overall rating of 3 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 $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 comprehensive coverage with varying costs depending on the service. Inpatient hospital stays require a $430 copay for days 1-5, and no copay for days 6-90. Outpatient services have no copay to a $400 copay, and emergency services have copays from $35 to $125. The plan also provides coverage for primary care with no copay, along with hearing, vision, and dental services with no copay for many services. You will also find additional benefits like home health services with no copay, and coverage for durable medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $430 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will also pay a $430 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay of $0 - $400, observation services with a $430 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Eagle (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (PPO) plan. Ground ambulance services have a $265 copay, while air ambulance services have a 20% coinsurance; 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 by the Aetna Medicare Eagle (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency and Urgent Coverage, and a $265 copay for Worldwide Emergency Transportation. There is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Eagle (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $20 copay. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services, all with a $40 copay, as well as other health care professional services with a copay between $0 and $35. Additionally, it offers additional telehealth benefits with a 20% coinsurance and a copay between $0 and $40. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and kidney disease education services with 20% coinsurance. Other services like health education, wigs for hair loss, and remote access technologies are covered with no copay.
Hearing Services See details
Hearing services with the Aetna Medicare Eagle (PPO) plan include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1250 per ear every year, and the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear.
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 $225.00 every year.
Dental Services See details
Dental services with the Aetna Medicare Eagle (PPO) plan include a $35 copay for Medicare dental services, with a $1,250 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Eagle (PPO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetics/Medical Supplies with no copay and 20% coinsurance for Medicare-covered items. Diabetic equipment is covered, with no copay for Diabetic Therapeutic Shoes/Inserts and a 0-20% coinsurance for Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Eagle (PPO) plan. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a maximum copay of $350.00, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under 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 covered by the Aetna Medicare Eagle (PPO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Eagle (PPO) plan. For days 1-20, the copay is $10, and for days 21-100, the copay is $214, while additional days beyond Medicare and non-Medicare stays are not covered.
Other Services See details
Under Other Services, acupuncture, meal benefits, 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. Over-the-counter (OTC) items and "Other 1" and "Other 2" benefits are covered with no copay.
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