2022 Aetna Medicare Eagle Plan (PPO)


Aetna Medicare Eagle Plan (PPO) H5521-229 is a 2022 Medicare Advantage Plan or Part-C by Aetna Medicare available to residents in Alabama. This plan does not provide additional prescription drug (Part-D) coverage. The Aetna Medicare Eagle Plan (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be a extremely nice safety net.

Aetna Medicare Eagle Plan (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Eagle Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.




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2022 Aetna Medicare Medicare Advantage Plan Costs

Name:
Aetna Medicare Eagle Plan (PPO)
Plan ID:
H5521-229
Provider:Aetna Medicare
Year:2022
Type: Local PPO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $5,500
Similar Plan: H5521-230




2021 Aetna Medicare Eagle Plan (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


Diagnostic services $0 copay
Diagnostic services $0 copay (Out-of-Network)
Endodontics $0 copay
Endodontics $0 copay (Out-of-Network)
Extractions $0 copay
Extractions $0 copay (Out-of-Network)
Non-routine services $0 copay
Non-routine services $0 copay (Out-of-Network)
Periodontics $0 copay
Periodontics $0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay (Out-of-Network)
Restorative services $0 copay
Restorative services $0 copay (Out-of-Network)



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $0-200 copay
Diagnostic radiology services (e.g., MRI) 35% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-95 copay
Diagnostic tests and procedures 35% coinsurance (Out-of-Network)
Lab services $0-10 copay
Lab services 35% coinsurance (Out-of-Network)
Outpatient x-rays $0-35 copay
Outpatient x-rays 35% coinsurance (Out-of-Network)



Doctor Visits


Primary $0 copay
Primary $30 copay per visit (Out-of-Network)
Specialist $45 copay per visit
Specialist $50 copay per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $50 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $45 copay
Foot exams and treatment $50 copay (Out-of-Network)
Routine foot care Not covered



Ground Ambulance


$290 copay
$290 copay (Out-of-Network)



Hearing


Fitting/evaluation $0 copay
Fitting/evaluation $50 copay (Out-of-Network)
Hearing aids $0 copay
Hearing aids $0 copay (Out-of-Network)
Hearing exam $45 copay
Hearing exam $50 copay (Out-of-Network)



Inpatient Hospital Coverage


$308 per day for days 1 through 7
$0 per day for days 8 through 90
35% per stay (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 0-20% coinsurance per item
Diabetes supplies 0-20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 35% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 35% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 35% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance
Other Part B drugs 35% coinsurance (Out-of-Network)



Mental Health Services


Inpatient hospital - psychiatric $295 per day for days 1 through 5
$0 per day for days 6 through 90
Inpatient hospital - psychiatric 35% per stay (Out-of-Network)
Outpatient group therapy visit $25 copay
Outpatient group therapy visit $50 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $25 copay
Outpatient group therapy visit with a psychiatrist $50 copay (Out-of-Network)
Outpatient individual therapy visit $25 copay
Outpatient individual therapy visit $50 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $25 copay
Outpatient individual therapy visit with a psychiatrist $50 copay (Out-of-Network)



MOOP


$11,300 In and Out-of-network
$6,400 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0-195 copay per visit
35% coinsurance per visit (Out-of-Network)



Preventive Care


$0 copay
$0 copay (Out-of-Network)



Preventive Dental


Cleaning $0 copay
Cleaning $0 copay (Out-of-Network)
Dental x-ray(s) $0 copay
Dental x-ray(s) $0 copay (Out-of-Network)
Fluoride treatment $0 copay
Fluoride treatment $0 copay (Out-of-Network)
Oral exam $0 copay
Oral exam $0 copay (Out-of-Network)



Rehabilitation Services


Occupational therapy visit $25 copay
Occupational therapy visit $50 copay (Out-of-Network)
Physical therapy and speech and language therapy visit $25 copay
Physical therapy and speech and language therapy visit $50 copay (Out-of-Network)



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100
35% per stay (Out-of-Network)



Transportation


Not covered



Vision


Contact lenses $0 copay
Contact lenses $0 copay (Out-of-Network)
Eyeglass frames $0 copay
Eyeglass frames $0 copay (Out-of-Network)
Eyeglass lenses $0 copay
Eyeglass lenses $0 copay (Out-of-Network)
Eyeglasses (frames and lenses) $0 copay
Eyeglasses (frames and lenses) $0 copay (Out-of-Network)
Other $45 copay
Other $50 copay (Out-of-Network)
Routine eye exam $0 copay
Routine eye exam $50 copay (Out-of-Network)
Upgrades $0 copay
Upgrades $0 copay (Out-of-Network)



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Aetna Medicare Eagle Plan (PPO) H5521



2021 Overall Rating
Part C Summary Rating
Part-D Summary 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


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Aetna Medicare Eagle Plan (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Aetna Medicare Eagle Plan (PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Aetna Medicare Eagle Plan (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



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1-855-778-4180
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Sun 9am-6pm EST




Coverage Area for Aetna Medicare Eagle Plan (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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