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Aetna Medicare Eagle (PPO)

Aetna Inc.
Aetna Medicare Eagle (PPO) H5521-286 Plan Details
4.5 out of 5 stars

Aetna Medicare Eagle (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-286

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Aetna Medicare Eagle (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-286

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Aetna Inc.
Aetna Medicare Eagle (PPO) H5521-286 Plan Details
4.5 out of 5 stars

Aetna Medicare Eagle (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-286

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$0.00
Monthly Premium

Illinois Counties Served

Lee Kendall Grundy Kankakee Winnebago Ogle Boone Kane Mchenry Cook Bureau Rock Island Stephenson Carroll Jo Daviess Lake Dupage Will Mercer Henry Dekalb Whiteside Hancock Henderson Warren

Michigan Counties Served

Delta Kalamazoo Van Buren Saint Joseph Allegan Berrien Cass Hillsdale Lenawee Muskegon Ottawa Wexford Antrim Kalkaska Dickinson Menominee Barry Marquette Houghton Shiawassee Kent Montcalm Eaton Calhoun Saint Clair Macomb Lapeer Oakland Sanilac Tuscola Washtenaw Wayne Livingston Monroe Huron Genesee Saginaw Gratiot Arenac Clare Bay Gladwin Ogemaw Oscoda Montmorency Roscommon Osceola Crawford Iosco Ingham Clinton Ionia Jackson Mecosta Branch Newaygo Lake Oceana Mason Benzie Emmet Manistee Missaukee Grand Traverse Leelanau Charlevoix Otsego Alger Luce Baraga Iron Ontonagon Keweenaw

Wisconsin Counties Served

Waukesha Washington Sheboygan Ozaukee Winnebago Trempealeau Langlade Brown Outagamie Shawano Forest Adams Marquette Dane Lafayette Milwaukee Walworth Racine Kenosha Manitowoc Waushara Marinette Oconto Florence Kewaunee Rock Green Iowa Columbia Portage Monroe Vernon La Crosse

Indiana Counties Served

Madison Hamilton Boone Hendricks Hancock Marion Johnson Morgan Shelby Lake Porter Pulaski Newton Jasper La Porte Starke Delaware Clinton Tipton Montgomery Tippecanoe Putnam Rush Grant Carroll Henry Bartholomew Howard Owen Fayette Parke Monroe Decatur Brown Franklin Kosciusko St Joseph Marshall Lagrange Adams Fulton Elkhart Noble Steuben Whitley Huntington Wabash Allen Jay Dekalb Wells Miami Cass Blackford White Ohio Ripley Union Dearborn Harrison Washington Randolph Switzerland Jennings Jefferson Clark Floyd Scott Clay Jackson Orange Lawrence Crawford Greene Perry Martin Dubois Sullivan Daviess Knox Spencer Warrick Pike Posey Gibson Vanderburgh Vigo Vermillion Warren Fountain Benton

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $-1
Out of Pocket Max In-Network: $4900
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
$0 in-network|50% out-of-network
Specialty Doctor Visit
In-Network|$30||Out-of-Network|50%
Inpatient Hospital Care
$300 per day, days 1-6; $0 per day, days 7-90 in-network|50% per stay out-of-network
Urgent Care
Copayment for Urgent Care $45

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $125
Maximum Plan Benefit of $100,000
Emergency Room Visit
$125 If you are admitted to the hospital within 0 hours your cost share may be waived
Ambulance Transportation
$290 in-network|$290 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Eagle (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Copayment for Medicare-covered Chiropractic Services $20
Out-of-Network:

Medicare Covered Chiropractic Services:
Coinsurance for Medicare Covered Chiropractic Services 50%
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network|0% for OneTouch/LifeScan diabetic supplies|20% for other covered diabetic supplies||Out-of-Network|0% for OneTouch/LifeScan diabetic supplies|20% for other covered diabetic supplies
Durable Medical Eqipment (DME)
In-Network|0% for continuous glucose monitors|20% for all other Medicare-covered DME items||Out-of-Network|20%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: In-Network|$0 ||Out-of-Network|50%
Diagnostic Procedures: In-Network|$0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD)||$75 for other diagnostic procedures and tests||Out-of-Network|50%
Imaging: Xray: $20 in-network|CT Scans: $250 in-network|Diagnostic Radiology other than CT Scans: $250 in-network|Diagnostic Radiology Mammogram: $0 in-network|50% out-of-network
Home Health Care
$0 in-network|50% out-of-network
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$300 per day for days 1 to 6
$0 per day for days 7 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Out-of-Network:

Psychiatric Hospital Services:
Coinsurance for Psychiatric Hospital per Stay 50%
Mental Health Outpatient Care
In-Network|$40 for Mental Health:
Group Sessions|$40 for Mental Health:
Individual Sessions|$40 for Psychiatric Services:
Group Sessions|$40 for Psychiatric Services:
Individual Sessions||Out-of-Network|50% for Mental Health Services- Group Sessions|50% for Mental Health Services - Individual Sessions|50% for Psychiatric Services:
Group Sessions|50% for Psychiatric Services:
Individual Sessions
Outpatient Services / Surgery
Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$300 all other ambulatory surgical center services||Out-of-Network|50%
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $75
Copayment for Medicare-covered Group Sessions $75
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Out-of-Network:

Medicare Covered Outpatient Substance Abuse Services:
Coinsurance for Medicare Covered Individual Sessions 50%
Coinsurance for Medicare Covered Group Sessions 50%
Over-the-counter (OTC) Items
$100 quarterly benefit amount (allowance) to purchase approved over-the-counter (OTC) health and wellness products. Approved items can be purchased online, in store, or by phone. Unused benefit amounts do not rollover.
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $30
Out-of-Network:

Medicare Covered Podiatry Services:
Coinsurance for Medicare Covered Podiatry Services 50%
Skilled Nursing Facility Care
$0 per day, days 1-20
$214 per day, days 21-100 in-network|50% per stay out-of-network

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network||Preventive dental services:|$0 for oral exams|$0 for cleanings|$0 for fluoride treatment|$0 for x-rays|$0 for other diagnostic dental services|$0 for other preventive dental services||Comprehensive dental services:|$0 for restorative services|$0 for endodontic services|$0 for periodontic services|$0 for removeable prosthodontics|$0 for fixed prosthodontics|$0 for oral and maxillofacial surgery|$0 for adjunctive services||Out-of-Network||Preventive dental services:|$0 for oral exams|$0 for cleanings|$0 for fluoride treatments|$0 for x-rays|$0 for other diagnostic dental services|$0 for other preventive dental services||Comprehensive dental services:|$0 for restorative services|$0 for endodontic services|$0 for periodontic services|$0 for removeable prosthodontics|$0 for fixed prosthodontics|$0 for oral and maxillofacial surgery|$0 for adjunctive services||$3,500 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services.||ADA recognized dental services are covered up to the benefit amount excluding implants and related services, orthodontics, cosmetic services, those considered medical in nature, and administrative charges. See EOC for a full list of exclusions.

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network||Eye Exams:|$0 for Diabetic eye exams|$30 for all other Medicare-covered eye exams|$0 for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year in or out-of-network)||Eyewear:|$0 for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||Out-of-Network||Eye Exams:|50% for Medicare-covered eye exams|50% for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year in or out-of-network)||Eyewear:|50% for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Eyeglass Lenses and Frames|$0 for Upgrades||$300 benefit amount (allowance) reimbursement every year for non-Medicare covered prescription eyewear.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network||Hearing Exams:|$30 for Medicare-covered hearing exams|$0 for non-Medicare covered hearing exams|(Maximum one non-Medicare covered hearing exam every year in or out-of-network)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0 for hearing aids|$1,500 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year)||Out-of-Network:||Hearing Exams:|50% for Medicare-covered hearing exams|50% for non-Medicare covered hearing exam every year in or out-of-network||Hearing Aids: You must purchase hearing aids through NationsHearing

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network|$0 copay for all preventive services covered under Original Medicare||Out-of-Network|0% for the pneumonia, influenza, Hepatitis B, and Covid-19 vaccines|50% for all other preventive services covered under Original Medicare
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