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Aetna Medicare Eagle (PPO)

H5521 - 323 - 0
4.5 out of 5 stars (4.5 / 5)

aetna-medicare medicare provider logo

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

This page features plan details for 2025 Aetna Medicare Eagle (PPO) H5521 – 323 – 0 available in Upstate NY Area: HV, Capital, CNY, Rochester, WNY.

Locations

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

Albany County, New York
Allegany County, New York
Broome County, New York

Click to see more locations

Plan Overview

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

Insurer:Aetna Medicare
Health Plan Deductible:$0
MOOP:$14,000 In and Out-of-network
$8,900 In-network
Drugs Covered:No

Ready to sign up for Aetna Medicare Eagle (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 (PPO) qualifies for a monthly Medicare Give Back Benefit of $55.00.

Premium Reduction:$55.00

Premium Breakdown

Aetna Medicare Eagle (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
$185.00 $0.00 $55.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

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

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

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Fluoride Treatment
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay (Limits Apply)
    • Out-of-Network: 20% Coins – No Copay (Limits Apply)

Diagnostic procedures/lab services/imaging

  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $35 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-300 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-35 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $30 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: 50% coinsurance (Authorization Required)

Doctor visits

  • Specialist
    • In-Network: $0-35 copay per visit
  • Primary
    • Out-of-Network: $25 copay per visit
    • In-Network: $0 copay
  • Specialist
    • Out-of-Network: $55 copay per visit

Emergency care/Urgent care

  • Emergency
    • $100 copay per visit (always covered)
  • Urgent care
    • $45 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • In-Network: $35 copay
    • Out-of-Network: $55 copay

Ground ambulance

    • In-Network: $300 copay
    • Out-of-Network: $300 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • Out-of-Network: $55 copay (Limits Apply)
  • Hearing aids
    • Out-of-Network: $0-1,700 copay (Limits Apply)
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $55 copay
  • Hearing aids
    • In-Network: $0-1,700 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $35 copay

Inpatient hospital coverage

    • In-Network: $375 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • Out-of-Network: 50% per stay (Authorization Required)

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

    • $14,000 In and Out-of-network
      $8,900 In-network

Medical equipment/supplies

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

Medicare Part B drugs

  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 50% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • Out-of-Network: 50% per stay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $339 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $40 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $40 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $40 copay (Authorization Required)
    • Out-of-Network: 50% coinsurance (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $40 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $0-350 copay per visit (Authorization Required)
    • Out-of-Network: 50% coinsurance per visit (Authorization Required)

Preventive care

    • Out-of-Network: 0-50% coinsurance
    • In-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $35 copay
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 50% coinsurance
  • Occupational therapy visit
    • Out-of-Network: 50% coinsurance
  • Physical therapy and speech and language therapy visit
    • In-Network: $40 copay

Skilled Nursing Facility

    • Out-of-Network: 50% per stay (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $203 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • Out-of-Network: $55 copay (Limits Apply)
  • Eyeglass frames
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Other
    • In-Network: $0 copay
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Other
    • Out-of-Network: $55 copay

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

    • Covered

Ready to sign up for Aetna Medicare Eagle (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

Table of Contents

Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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