2023 Aetna Medicare Eagle II (PPO)

Aetna Medicare Eagle II (PPO) H2293-012 is a 2023 Medicare Advantage Plan or Part-C by Aetna Medicare available to residents in Texas. This plan does not provide extra prescription drug (Part-D) coverage. Aetna Medicare Aetna Medicare Eagle II (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,000 out-of-pocket. This can be an extremely nice safety net.

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 II (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in Texas.



2023 Aetna Medicare Medicare Advantage Plan Overview

Name:Aetna Medicare Eagle II (PPO)
Plan ID:H2293 012 0
Provider:Aetna Medicare
Year:2023
Type:Local PPO *
Combined Premium (C+D):$0/mo
MOOP:$5,000/yr
Similar Plan: H2293-013




What type of plan is Aetna Medicare Eagle II (PPO)

Aetna Medicare Eagle II (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.

How much does Aetna Medicare Eagle II (PPO) cost?


Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Aetna Medicare charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Aetna Medicare Eagle II (PPO) by Aetna Medicare MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.





2023 Summary of Benefits


The benefit information provided is a summary of what Aetna Medicare Eagle II (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Aetna Medicare helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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



Contact lenses


In-Network Vision$0 copay
Out-of-Network Vision$0 copay



Eyeglass frames


In-Network Vision$0 copay
Out-of-Network Vision$0 copay



Eyeglass lenses


Out-of-Network Vision$0 copay
In-Network Vision$0 copay



Eyeglasses (frames and lenses)


In-Network Vision$0 copay
Out-of-Network Vision$0 copay



Other


Out-of-Network Vision30% coinsurance
In-Network Vision$0 copay



Routine eye exam


In-Network Vision$0 copay
Out-of-Network Vision30% coinsurance



Upgrades


Out-of-Network Vision$0 copay
In-Network Vision$0 copay




TransportationNot covered
In-Network Skilled Nursing Facility$10 per day for days 1 through 20
$196 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility30% per stay



Occupational therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services30% coinsurance



Physical therapy and speech and language therapy visit


In-Network Rehabilitation services$40 copay
Out-of-Network Rehabilitation services30% coinsurance



Cleaning


In-Network Preventive dental$0 copay
Out-of-Network Preventive dental30% coinsurance



Dental x-ray(s)


Out-of-Network Preventive dental30% coinsurance
In-Network Preventive dental$0 copay



Fluoride treatment


Preventive dentalNot covered



Oral exam


Out-of-Network Preventive dental30% coinsurance
In-Network Preventive dental$0 copay




Out-of-Network Preventive care0-30% coinsurance
In-Network Preventive care$0 copay
In-Network Outpatient hospital coverage$0-350 copay per visit
Out-of-Network Outpatient hospital coverage30% coinsurance per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Out-of-Network Mental health services30% per stay
In-Network Mental health services$1,871 per stay



Outpatient group therapy visit


Out-of-Network Mental health services30% coinsurance
In-Network Mental health services$40 copay



Outpatient group therapy visit with a psychiatrist


In-Network Mental health services$40 copay
Out-of-Network Mental health services30% coinsurance



Outpatient individual therapy visit


Out-of-Network Mental health services30% coinsurance
In-Network Mental health services$40 copay



Outpatient individual therapy visit with a psychiatrist


Out-of-Network Mental health services30% coinsurance
In-Network Mental health services$40 copay



Chemotherapy


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs30% coinsurance



Other Part B drugs


In-Network Medicare Part B drugs20% coinsurance
Out-of-Network Medicare Part B drugs30% coinsurance



Diabetes supplies


In-Network Medical equipment/supplies0-20% coinsurance per item
Out-of-Network Medical equipment/supplies0-20% coinsurance per item



Durable medical equipment (e.g., wheelchairs, oxygen)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies30% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


In-Network Medical equipment/supplies20% coinsurance per item
Out-of-Network Medical equipment/supplies30% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$8,950 In and Out-of-network
$5,000 In-network
In-Network Inpatient hospital coverage$365 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network Inpatient hospital coverage30% per stay



Fitting/evaluation


Out-of-Network Hearing30% coinsurance
In-Network Hearing$0 copay



Hearing aids


Out-of-Network Hearing$0 copay
In-Network Hearing$0 copay



Hearing exam


Out-of-Network Hearing30% coinsurance
In-Network Hearing$40 copay




Health plan deductible$0
Out-of-Network Ground ambulance$270 copay
In-Network Ground ambulance$270 copay



Foot exams and treatment


In-Network Foot care (podiatry services)$40 copay
Out-of-Network Foot care (podiatry services)30% coinsurance



Routine foot care


Foot care (podiatry services)Not covered



Emergency


Emergency care/Urgent care$110 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$0-60 copay per visit (always covered)



Primary


In-Network Doctor visits$0 copay
Out-of-Network Doctor visits30% coinsurance per visit



Specialist


In-Network Doctor visits$40 copay per visit
Out-of-Network Doctor visits30% coinsurance per visit



Diagnostic radiology services (e.g., MRI)


Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-375 copay



Diagnostic tests and procedures


Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance
In-Network Diagnostic procedures/lab services/imaging$0-50 copay



Lab services


In-Network Diagnostic procedures/lab services/imaging$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance



Outpatient x-rays


In-Network Diagnostic procedures/lab services/imaging$40 copay
Out-of-Network Diagnostic procedures/lab services/imaging30% coinsurance



Diagnostic services


Out-of-Network Comprehensive dental50-70% coinsurance
In-Network Comprehensive dental$0 copay



Endodontics


In-Network Comprehensive dental20% coinsurance
Out-of-Network Comprehensive dental50-70% coinsurance



Extractions


In-Network Comprehensive dental20-50% coinsurance
Out-of-Network Comprehensive dental50-70% coinsurance



Non-routine services


Out-of-Network Comprehensive dental50-70% coinsurance
In-Network Comprehensive dental20-50% coinsurance



Periodontics


Out-of-Network Comprehensive dental50-70% coinsurance
In-Network Comprehensive dental20-50% coinsurance



Prosthodontics, other oral/maxillofacial surgery, other services


In-Network Comprehensive dental50% coinsurance
Out-of-Network Comprehensive dental50-70% coinsurance



Restorative services


In-Network Comprehensive dental20-50% coinsurance
Out-of-Network Comprehensive dental50-70% coinsurance




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No




Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Aetna Medicare Eagle II (PPO) requires you to live in that plan’s service area. The service area is listed below:



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How much does Aetna Medicare Eagle II (PPO) cost?

Aetna Medicare charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is Aetna Medicare Eagle II (PPO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. Aetna Medicare Eagle II (PPO) by Aetna Medicare MOOP is $5,000. Once you spend $5,000 you will pay nothing for Part A or Part B covered services.

What type of plan is Aetna Medicare Eagle II (PPO)?

Aetna Medicare Eagle II (PPO) is a Local PPO *. A (PPO) is a Medicare plan that has contracts with a network of preferred providers. You do not need to select a primary care physician and you do not need referrals to see other providers in the network.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. Enrollment depends on the plan’s contract renewal.

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