Aetna Medicare Eagle Plus II Plan (PPO)

H5309 - 004 - 0
0 out of 5 stars (0 / 5)

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Aetna Medicare Eagle Plus II Plan (PPO) is a Medicare Advantage Plan by Aetna Medicare.

This page features plan details for 2024 Aetna Medicare Eagle Plus II Plan (PPO) H5309 – 004 – 0 available in Northern California.

IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:

Locations

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

Plan Overview

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

Insurer:Aetna Medicare
Health Plan Deductible:$0.00
MOOP:$9,500 In and Out-of-network
$6,700 In-network
Drugs Covered:No

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

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Aetna Medicare Eagle Plus II Plan (PPO) qualifies for a monthly Medicare Give Back Benefit of $25.00.

Premium Reduction:$25.00

Premium Breakdown

Aetna Medicare Eagle Plus II 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
$174.70 $0.00 $25.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

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

Health plan deductible

$0

Other health plan deductibles?

In-network No

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

$9,500 In and Out-of-network
$6,700 In-network

Optional supplemental benefits

No

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

In-network No

Outpatient hospital coverage

In-network $0-350 copay per visit (Authorization is required.) (Referral is not required.)
out-of-network 50% coinsurance per visit (Authorization is required.) (Referral is not required.)

Doctor visits

In-network Primary$0 copay (Not applicable.) (Not applicable.)
out-of-network Primary50% coinsurance per visit (Not applicable.) (Not applicable.)
In-network Specialist$40 copay per visit (Authorization is not required.) (Referral is not required.)
out-of-network Specialist50% coinsurance per visit (Authorization is not required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network 0-50% coinsurance (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$100 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$40 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$0-10 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures50% coinsurance (Authorization is required.) (Referral is not required.)
In-network Lab services$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Lab services50% coinsurance (Authorization is required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0-150 copay (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)50% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient x-rays$0 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient x-rays50% coinsurance (Authorization is required.) (Referral is not required.)

Hearing

In-network Hearing exam$0 copay (Authorization is not required.) (Referral is not required.)
out-of-network Hearing exam50% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Fitting/evaluation$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fitting/evaluation50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Hearing aids$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Hearing aids$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Oral exam20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Cleaning20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fluoride treatment20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Dental x-ray(s)20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

In-network Non-routine services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Non-routine services20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Diagnostic services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Diagnostic services20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Restorative services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Restorative services20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Endodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Endodontics20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Periodontics$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Periodontics20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Extractions$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Extractions20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)
In-network Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.)
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Routine eye exam50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Other$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
out-of-network Other50% coinsurance (There are no limits.) (Authorization is not required.) (Referral is not required.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglass frames$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglass lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Upgrades$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Upgrades$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Rehabilitation services

In-network Occupational therapy visit$20 copay (Authorization is not required.) (Referral is not required.)
out-of-network Occupational therapy visit50% coinsurance (Authorization is not required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$20 copay (Authorization is not required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit50% coinsurance (Authorization is not required.) (Referral is not required.)

Ground ambulance

In-network $265 copay (Not applicable.) (Not applicable.)
out-of-network $265 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Foot exams and treatment50% coinsurance (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)0-20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)40% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)40% coinsurance per item (Authorization is required.) (Not applicable.)
In-network Diabetes supplies0-20% coinsurance per item (Authorization is required.) (Not applicable.)
out-of-network Diabetes supplies0-20% coinsurance per item (Authorization is required.) (Not applicable.)

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

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Chemotherapy50% coinsurance (Authorization is required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is required.) (Not applicable.)
out-of-network Other Part B drugs50% coinsurance (Authorization is required.) (Not applicable.)
In-network Part B Insulin drugs$35 copay (Authorization is required.) (Not applicable.)
out-of-network Part B Insulin drugs50% coinsurance (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

In-network $430 per day for days 1 through 4
$0 per day for days 5 through 90 (Authorization is required.) (Referral is not required.)
out-of-network 49% per stay (Authorization is required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$430 per day for days 1 through 4
$0 per day for days 5 through 90 (Authorization is required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric50% per stay (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist50% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist50% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient group therapy visit$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient group therapy visit50% coinsurance (Authorization is required.) (Referral is not required.)
In-network Outpatient individual therapy visit$40 copay (Authorization is required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit50% coinsurance (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$150 per day for days 21 through 100 (Authorization is required.) (Referral is not required.)
out-of-network 48% per stay (Authorization is required.) (Referral is not required.)

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

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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