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Aetna Medicare Eagle Plan (PPO)

H5521 - 349 - 0
3.5 out of 5 stars (3.5 / 5)

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Aetna Medicare Eagle Plan (PPO) is a Medicare Advantage (Part C) Plan by Aetna Medicare.

This page features plan details for 2023 Aetna Medicare Eagle Plan (PPO) H5521 – 349 – 0 available in Maine & New Hampshire.

IMPORTANT: This page has been updated with plan and premium data for 2023.

Locations

Aetna Medicare Eagle Plan (PPO) is offered in the following locations.

Androscoggin County, Maine
Aroostook County, Maine
Belknap County, New Hampshire

Click to see more locations

Plan Overview

Aetna Medicare Eagle Plan (PPO) offers the following coverage and cost-sharing.

Insurer:Aetna Medicare
Health Plan Deductible:$0.00
MOOP:$5,900 In and Out-of-network
$5,900 In-network
Drugs Covered:No

Ready to sign up for Aetna Medicare Eagle Plan (PPO) ?

Get help from a licensed insurance agent.

Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

Premium Breakdown

Aetna Medicare Eagle Plan (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$164.90 $0.00 $0.00 $164.90
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Aetna Medicare Eagle Plan (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Diagnostic services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Endodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Extractions:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Periodontics:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services:In-Network: $0 copay (limits may apply) (authorization required) (referral not required)
Restorative services:Out-of-Network: $0 copay (limits may apply) (authorization required) (referral not required)

Dental (preventive)

Cleaning:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Cleaning:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):In-Network: $0-100 copay (authorization required) (referral not required)
Diagnostic radiology services (e.g., MRI):Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Diagnostic tests and procedures:In-Network: $0-45 copay (authorization required) (referral not required)
Diagnostic tests and procedures:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Lab services:In-Network: $0 copay (authorization required) (referral not required)
Lab services:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient x-rays:In-Network: $0-15 copay (authorization required) (referral not required)
Outpatient x-rays:Out-of-Network: 50% coinsurance (authorization required) (referral not required)

Doctor visits

Primary:In-Network: $0 copay
Primary:Out-of-Network: 50% coinsurance per visit
Specialist:In-Network: $40 copay per visit (authorization not required) (referral not required)
Specialist:Out-of-Network: 50% coinsurance per visit (authorization not required) (referral not required)

Emergency care/Urgent care

Emergency: $95 copay per visit (always covered)
Urgent care: $0-45 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:In-Network: $40 copay (authorization not required) (referral not required)
Foot exams and treatment:Out-of-Network: 50% coinsurance (authorization not required) (referral not required)
Routine foot care: Not covered

Ground ambulance

In-Network: $270 copay
Out-of-Network: $270 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Fitting/evaluation:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Hearing aids:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Hearing aids:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Hearing exam:In-Network: $40 copay (authorization not required) (referral not required)
Hearing exam:Out-of-Network: 50% coinsurance (authorization not required) (referral not required)

Hospital coverage (inpatient)

In-Network: $345 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required) (referral not required)
Out-of-Network: 50% per stay (authorization required) (referral not required)

Hospital coverage (outpatient)

In-Network: $0-295 copay per visit (authorization required) (referral not required)
Out-of-Network: 50% coinsurance per visit (authorization required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$5,900 In and Out-of-network
$5,900 In-network

Medical equipment/supplies

Diabetes supplies:In-Network: 0-20% coinsurance per item (authorization required)
Diabetes supplies:Out-of-Network: 0-20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 50% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):In-Network: 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 50% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:In-Network: 20% coinsurance (authorization required)
Chemotherapy:Out-of-Network: 50% coinsurance (authorization required)
Other Part B drugs:In-Network: 20% coinsurance (authorization required)
Other Part B drugs:Out-of-Network: 50% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:In-Network: $420 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required) (referral not required)
Inpatient hospital – psychiatric:Out-of-Network: 50% per stay (authorization required) (referral not required)
Outpatient group therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Outpatient group therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:In-Network: $40 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Outpatient individual therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:In-Network: $40 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required) (referral not required)

Optional supplemental benefits

No

Preventive care

In-Network: $0 copay (authorization not required) (referral not required)
Out-of-Network: 0-50% coinsurance (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Occupational therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:In-Network: $40 copay (authorization required) (referral not required)
Physical therapy and speech and language therapy visit:Out-of-Network: 50% coinsurance (authorization required) (referral not required)

Skilled Nursing Facility

In-Network: $0 per day for days 1 through 20
$196 per day for days 21 through 51
$0 per day for days 52 through 100 (authorization required) (referral not required)
Out-of-Network: 50% per stay (authorization required) (referral not required)

Transportation

Not covered

Vision

Contact lenses:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Contact lenses:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Other:In-Network: $0 copay (no limits) (authorization not required) (referral not required)
Other:Out-of-Network: 50% coinsurance (no limits) (authorization not required) (referral not required)
Routine eye exam:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Routine eye exam:Out-of-Network: 50% coinsurance (limits may apply) (authorization not required) (referral not required)
Upgrades:In-Network: $0 copay (limits may apply) (authorization not required) (referral not required)
Upgrades:Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required)

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization not required) (referral not required)

Ready to sign up for Aetna Medicare Eagle Plan (PPO) ?

Get help from a licensed insurance agent.

Click to Call 1-877-354-4611 TTY 711.
Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.

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