2027 Medicare Advantage plan
Aetna Medicare Eagle Giveback (PPO): 2027 benefits and costs
Aetna Medicare PPO
CMS plan ID: H5521-488-0 · Plan year: 2027
Aetna Medicare Eagle Giveback (PPO) is a 2027 Medicare Advantage plan offered by Aetna Medicare. It is listed in Kentucky.
2027 plan costs at a glance
- Organization
- Aetna Medicare
- Plan organization
- AETNA LIFE INSURANCE COMPANY
- Parent company
- CVS Health Corporation
- Plan type
- PPO
- 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
- $84.50 (estimated)$209.50 standard premium less $125.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $6,900.00
Applies to certain in-network supplemental services.
- Combined in/out-of-network medical maximum
- $9,950.00
Applies to certain out-of-network supplemental services and certain in-network supplemental services.
- Out-of-network medical maximum
- Not applicable
- Part B premium reduction
- $125.00
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0.00 copay
| 50% coinsurance
| |
| Specialist visit | $0.00 to $30.00 copay
| 50% coinsurance
|
|
| Telehealth | $0.00 to $40.00 copay; 20% coinsurance
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $130.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0.00 copay
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 50% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Kidney disease education services | 20% coinsurance
| 50% coinsurance
|
|
| Medicare-covered chiropractic | $15.00 copay
| 50% coinsurance
|
|
| Medicare-covered foot care | $30.00 copay
| 50% coinsurance
|
|
| Other health professionals | $0.00 to $30.00 copay
| $0.00 to $40.00 copay
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–7: $380.00 copay per day Days 8–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–7: $290.00 copay per day Days 8–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $380.00 copay
| 50% coinsurance
| |
| Hospital observation services | $380.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $0.00 to $300.00 copay
| 50% coinsurance
|
|
| Outpatient blood | $0.00 copay
| 50% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $75.00 copay
| 50% coinsurance
|
|
| Laboratory services | $0.00 copay
| 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $325.00 copay
| 50% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 50% coinsurance
|
|
| X-rays | $10.00 to $125.00 copay
| 50% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $70.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $70.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $40.00 copay
| 50% coinsurance
|
|
| Substance use treatment, group sessions | $40.00 copay
| 50% coinsurance
|
|
| Opioid treatment program | $40.00 copay
| 50% coinsurance
|
|
| Mental health, individual sessions | $40.00 copay
| 50% coinsurance
|
|
| Mental health, group sessions | $40.00 copay
| 50% coinsurance
|
|
| Psychiatry, individual sessions | $40.00 copay
| 50% coinsurance
|
|
| Psychiatry, group sessions | $40.00 copay
| 50% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $35.00 copay
| 50% coinsurance
|
|
| Physical and speech therapy | $35.00 copay
| 50% coinsurance
|
|
| Cardiac rehabilitation | $20.00 copay
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $20.00 copay
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $20.00 copay
| 50% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $280.00 copay
| $280.00 copay
|
|
| Air ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | 0% to 20% coinsurance
| 0% to 20% coinsurance
|
|
| Diabetic shoes and inserts | $0.00 copay
| 20% coinsurance
|
|
| Diabetic monitors | 0% to 20% coinsurance
| 0% to 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $30.00 copay | 50% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 50% coinsurance | 70% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 50% coinsurance | 70% coinsurance
| |
| Oral surgeryAdditional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
| |
| Other dental servicesAdditional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0.00 to $30.00 copay
| 50% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Medicare-covered eyewear | $0.00 copay
| 50% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglass lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglass framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Other Eye Exam ServicesAdditional plan benefit | Out-of-network | 50% coinsurance
| |
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| UpgradesAdditional plan benefit | Out-of-network | $0.00 copay
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $30.00 copay
| 50% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | 50% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay | 50% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0.00 copay
| $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| $0.00 copay
| |
| Annual physical examAdditional plan benefit | $0.00 copay
| 50% coinsurance
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | 50% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 0% to 50% coinsurance
| |
| Health EducationAdditional plan benefit | Out-of-network | $0.00 copay
|
|
| Additional Sessions of Smoking and Tobacco Cessation CounselingAdditional plan benefit | Out-of-network | 50% coinsurance
|
|
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0.00 copay
|
|
| Wigs for chemotherapy-related hair lossAdditional plan benefit | Out-of-network | $0.00 copay
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | $0.00 copay
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | $0.00 copay
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $35.00 copay
|
Allowances and optional benefits
Benefits for qualifying members
Cancer Care
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Other 1
- Qualifying conditions
- Cancer
- To qualify
- High value provider
- Covered package services cost $0 until the package limit is reached
- No
- Benefits that apply to reduced cost sharing
- Medicare-covered benefits
- Medicare benefits that apply to reduced cost sharing
- Physician Specialist Services; Additional Telehealth Benefits
- Does your MA Uniformity Flexibility/SSBCI cost reduction cover all or some Specialists under Physician Specialist Services?
- Some specialists
- Applies to out-of-network or point-of-service care
- No
- Some package benefits are exempt from the deductible
- Yes
- Benefits that apply to being exempt from the plan-level deductible
- Medicare-covered benefits
- Medicare benefits that are exempt from the plan level deductible
- Physician Specialist Services; Additional Telehealth Benefits
- Do you offer reduced Coinsurance?
- No
- Service-specific deductible
- No
- Reduced Copayment?
- Yes
- Types of benefits that apply to the copayment cost sharing
- Medicare-covered benefits
- Medicare-covered benefits that will receive reduced Copayment
- Additional Telehealth Benefits
- Minimum Copayment for Additional Telehealth Benefits
- $0.00
- Maximum Copayment for Additional Telehealth Benefits
- $0.00
- Specialists reduced coinsurance?
- No
- Specialists reduced copayment?
- Yes
- Specialists with the reduced copayment
- Oncology - Radiation/Radiation Oncology; Oncology - Medical, Surgical
- Minimum Copayment Amount for Oncology - Medical, Surgical
- $0.00
- Maximum Copayment Amount for Oncology - Medical, Surgical
- $0.00
- Minimum Copayment Amount for Oncology - Radiation/Radiation Oncology
- $0.00
- Maximum Copayment Amount for Oncology - Radiation/Radiation Oncology
- $0.00
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 75 county listings across 1 state or territory
Kentucky
- Allen, Kentucky
- Bath, Kentucky
- Bell, Kentucky
- Boone, Kentucky
- Boyd, Kentucky
- Bracken, Kentucky
- Bullitt, Kentucky
- Butler, Kentucky
- Calloway, Kentucky
- Campbell, Kentucky
- Carroll, Kentucky
- Carter, Kentucky
- Clark, Kentucky
- Clay, Kentucky
- Edmonson, Kentucky
- Elliott, Kentucky
- Fayette, Kentucky
- Fleming, Kentucky
- Floyd, Kentucky
- Franklin, Kentucky
- Gallatin, Kentucky
- Garrard, Kentucky
- Grant, Kentucky
- Graves, Kentucky
- Grayson, Kentucky
- Greenup, Kentucky
- Hancock, Kentucky
- Hardin, Kentucky
- Harlan, Kentucky
- Harrison, Kentucky
- Hart, Kentucky
- Henderson, Kentucky
- Henry, Kentucky
- Hopkins, Kentucky
- Jefferson, Kentucky
- Jessamine, Kentucky
- Johnson, Kentucky
- Kenton, Kentucky
- Knott, Kentucky
- Larue, Kentucky
- Lawrence, Kentucky
- Leslie, Kentucky
- Letcher, Kentucky
- Logan, Kentucky
- Madison, Kentucky
- Magoffin, Kentucky
- Marshall, Kentucky
- Martin, Kentucky
- Mason, Kentucky
- McCracken, Kentucky
- McCreary, Kentucky
- McLean, Kentucky
- Meade, Kentucky
- Montgomery, Kentucky
- Morgan, Kentucky
- Muhlenberg, Kentucky
- Nelson, Kentucky
- Nicholas, Kentucky
- Oldham, Kentucky
- Owen, Kentucky
- Pendleton, Kentucky
- Perry, Kentucky
- Pike, Kentucky
- Pulaski, Kentucky
- Robertson, Kentucky
- Rockcastle, Kentucky
- Rowan, Kentucky
- Scott, Kentucky
- Shelby, Kentucky
- Simpson, Kentucky
- Spencer, Kentucky
- Taylor, Kentucky
- Trimble, Kentucky
- Warren, Kentucky
- Whitley, Kentucky