2027 Medicare Advantage plan

Aetna Medicare Advantra Eagle Plus (HMO): 2027 benefits and costs

Aetna Medicare HMO

CMS plan ID: H1692-006-0 · Plan year: 2027

Aetna Medicare Advantra Eagle Plus (HMO) is a 2027 Medicare Advantage plan offered by Aetna Medicare. It is listed in West Virginia.

2027 plan costs at a glance

Monthly plan premium$0.00
In-network medical out-of-pocket maximum$6,900.00
Organization
Aetna Medicare
Plan organization
COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.
Parent company
CVS Health Corporation
Plan type
HMO
Part C premium
$0.00
Prescription drug coverage
No
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)
Monthly Part B premium after plan reduction
$59.50 (estimated)$209.50 standard premium less $150.00 plan reduction.

You must continue to pay your Medicare Part B premium.

In-network medical deductible
None
In-network medical maximum
$6,900.00

Applies to certain in-network supplemental services.

Part B premium reduction
$150.00

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0.00 copay

Service-specific deductible
No
Specialist visit

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Telehealth

$0.00 to $50.00 copay; 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
Emergency care

$130.00 copay

Urgent care

$50.00 copay

Home health

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered foot care

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Other health professionals

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–7: $295.00 copay per day

Days 8–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–9: $176.00 copay per day

Days 10–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $10.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $250.00 copay

Service-specific deductible
No
Hospital observation services

$250.00 copay

Service-specific deductible
No
Ambulatory surgical center

$0.00 to $200.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Outpatient blood

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Laboratory services

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Diagnostic radiology (CT, MRI)

$0.00 to $275.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
X-rays

$15.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Opioid treatment program

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, individual sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, group sessions

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Physical and speech therapy

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Cardiac rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Intensive cardiac rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Pulmonary rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Supervised exercise for peripheral artery disease

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$250.00 copay

Service-specific deductible
No
Approval required
Yes
Air ambulance

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic shoes and inserts

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic monitors

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$10.00 copay

Oral examsAdditional plan benefit

$0.00 copay

Dental X-raysAdditional plan benefit

$0.00 copay

Other diagnostic dentalAdditional plan benefit

$0.00 copay

Dental cleaningAdditional plan benefit

$0.00 copay

FluorideAdditional plan benefit

$0.00 copay

Other preventive dentalAdditional plan benefit

$0.00 copay

Restorative dental careAdditional plan benefit

$0.00 copay

Root canal treatment (endodontics)Additional plan benefit

$0.00 copay

Gum treatment (periodontics)Additional plan benefit

$0.00 copay

Removable dentures (prosthodontics)Additional plan benefit

$0.00 copay

Fixed dental restorations (prosthodontics)Additional plan benefit

$0.00 copay

Oral surgeryAdditional plan benefit

$0.00 copay

Other dental servicesAdditional plan benefit

$0.00 copay

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine eye examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Medicare-covered eyewear

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Contact lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$10.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine hearing examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Prescription hearing aids (all types)Additional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Over-the-counter health itemsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Limited-duration mealsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Allowances and optional benefits

Benefits for qualifying members

SSBCI Pkg

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning; Other 1; Other 2; Other 3; Other 4
Qualifying conditions
Anemia
Qualifying conditions
Chronic Hyperlipidemia
Qualifying conditions
Chronic Hypertension
Qualifying conditions
Chronic Pain
Included services
Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit
Some package benefits are exempt from the deductible
Yes
Services exempt from the deductible
Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit
Package limit
$30.00
How often this limit applies
Every three months
How benefits are provided
Debit Card
Services sharing the package limit
Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit

Prescription drug coverage

This plan does not include a Part D prescription drug benefit.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 38 county listings across 1 state or territory

West Virginia