Aetna Medicare Eagle Plan (PPO) H5521-241-0 Plan Details
Aetna Medicare Eagle Plan (PPO) H5521-241-0 Plan Details
Choosing the right Medicare Advantage plan is crucial for your healthcare needs in 2025. With Aetna Medicare Eagle Plan (PPO) as one of the options, you can compare it side-by-side with other available plans to find the best fit. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
Aetna Medicare Eagle Plan Overview
Plan ID H5521-241-0 Overview | |
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Health Plan ID: | H5521-241-0 |
Medicare Advantage Plan Type: | Local PPO |
Plan Year: | 2024 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $6,500 |
Part B Give Back: | $50.00/mo |
Part D Drug Plan Benefit: | Not Included |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Aetna Medicare |
Why Choose Aetna Medicare Eagle Plan?
Aetna Medicare Eagle Plan is a Medicare Advantage Preferred Provider Organization (PPO) plan that offers flexibility and comprehensive healthcare coverage. With a monthly premium of $0.00, this plan provides all the benefits of Medicare Part A and Part B, ensuring you have access to essential medical services. As a PPO plan, Aetna Medicare Eagle Plan allows you to see any Medicare-approved provider, but you’ll typically pay less when using providers within the plan’s network.
It’s important to note that Aetna Medicare Eagle Plan does not include prescription drug coverage (Part D). If you require prescription drug coverage, consider exploring Medicare Part D plans. Additionally, Aetna Medicare Eagle Plan features an annual maximum out-of-pocket (MOOP) limit of $6,500, offering financial protection by capping your healthcare expenses. Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Aetna Medicare Eagle Plan an excellent choice for those seeking flexibility and comprehensive coverage.
We're Here to Help You Enroll |
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Out-of-Pocket Expenses
Aetna Medicare Eagle Plan includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H5521-241-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $35 Copay |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $35 Copay |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $15 Copay Prior Authorization Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $100 Copay |
Urgent care: | $35 Copay |
Ground ambulance: | $275 Copay |
Inpatient hospital care: | $300.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
Outpatient hospital care: | $200 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $40 Copay |
Outpatient group therapy: | $40 Copay |
Inpatient psychiatric hospital care: | $240.00 per day for days 1 through 8 $0.00 per day for days 9 and beyond |
Outpatient group therapy: | $40 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $20 Copay |
Occupational therapy: | $20 Copay |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $120 Copay Prior Authorization Required |
Lab services: | $0 Copay Prior Authorization Required |
Outpatient x-rays: | $14 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $75 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Aetna Medicare Eagle Plan as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Aetna Medicare offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay |
Vision | Maximum vision benefit: | $300.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
Understanding CMS Star Ratings
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Plan Availability
Aetna Medicare Eagle Plan (H5521-241-0) is available in the following locations (click to open):
Eligibility Requirements for Aetna Medicare Eagle Plan
To enroll in Aetna Medicare Eagle Plan, you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
- Not have End-Stage Renal Disease (ESRD), with some exceptions.
If you meet these requirements, you are eligible to enroll in Aetna Medicare Eagle Plan and benefit from its comprehensive coverage options.
Enrollment Periods for Aetna Medicare Eagle Plan
Knowing when you can enroll in Aetna Medicare Eagle Plan is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) for expert guidance from a licensed insurance agent.
How to Sign Up for Aetna Medicare Eagle Plan
Getting started with Aetna Medicare Eagle Plan is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with Aetna Medicare Eagle Plan. The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Contact Aetna Medicare
Website: | http://www.aetnamedicare.com |
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Formulary: | http://www.aetnamedicare.com/findpharmacy |
Pharmacy: | Aetna Medicare Pharmacy Page |
New Members: | (833)859-6031 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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