Your Aetna Eagle (no rx) PPO
EyeMed link: AetnaMedicareVision.com
Dental link: https://shorturl.at/RoEcQ
Nations Hearing: Aetna.Nationsbenefits.com/Hearing
Find A Doc: Aetnamedicare.com/en/find-doctors-hospitals/find-provider.html
Helpful Plan Resources: http://AetnaMedicare.com/H5521-286
Aetna Customer Service: 1-833-570-6670
2025
2026
Aetna Eagle PPO
Aetna Eagle PPO
H5521-286
H5521-286
Part B Giveback
$70/month
$70/month
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$0 / 50%
$0 / 50%
Specialist
$30 / 50%
$30 / 50%
Physical Therapy
$30 / 50%
$30 / 50%
Urgent Care
$45
$45
Hospital
$300 days 1-6
$300 days 1-6
Out of Network
50%
50%
Maximum Out Of Pocket
$4,900 / $8,000
(for in- and out-of-network services combined)
$4,900 / $10,100
(for in- and out-of-network services combined)
Outpatient Surgery
$350 / 50%
$300 / 50%
Ambulance
$290 / 20% (air)
$290 / 20% (air)
Emergency
$125
$130
Lab Services
$0 / 50%
$0 / 50%
X-Rays
$20 / 50%
$20 / 50%
Complex Diagnostic
$250 / 50%
$250 / 50%
Part D
N/A
N/A
Hearing Aid
$1,500 Allowance Per Ear
$1,500 Allowance per ear
OTC
$100 / Quarter
$100 / Quarter
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$3,500 Direct Member Reimbursement
$3,750
100% covered for in-network preventive and comprehensive services
Dental Network
Aetna Dental Medicare / Any dentist
Aetna Dental PPO Network / Out of Network 20% coinsurance
Vision
$300 (Eye Med)
$300 (Eye Med)
Direct Member Reimbursement
N/A
$90 Per Quarter Fitness Reimbursement
Your Aetna Eagle (no rx) PPO
2025
2026
Aetna Eagle PPO
Aetna Eagle PPO
H5521-150
H5521-150
Part B Giveback
$70/month
$70/month
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$0 / 50%
$0 / 50%
Specialist
$30 / 50%
$30 / 50%
Physical Therapy
$30 / 50%
$30 / 50%
Urgent Care
$45
$45
Hospital
$300 days 1-6
$300 days 1-6
Out of Network
50%
50%
MOOP Cap
$4,900 / $8,000
(for in- and out-of-network services combined)
$4,900 / $10,100
(for in- and out-of-network services combined)
Outpatient Surgery
$350 / 50%
$300 / 50%
Ambulance
$290 / 20% (air)
$290 / 20% (air)
Emergency
$125
$130
Lab Services
$0 / 50%
$0 / 50%
X-Rays
$20 / 50%
$20 / 50%
Complex Diagnostic
$250 / 50%
$250 / 50%
Part D
N/A
N/A
Hearing Aid
$1,500 Allowance Per Ear
$1,500 Allowance Per Ear
OTC
$100 / Quarter
$100 / Quarter
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$3,500 Direct Member Reimbursement
$3,750
100% covered for in-network preventive and comprehensive services
Dental Network
Aetna Dental Medicare / Any dentist
Aetna Dental PPO Network / Out of Network 20% coinsurance
Vision
$300 (Eye Med)
$300 (Eye Med)
Direct Member Reimbursement
N/A
$90 Per Quarter Fitness Reimbursement
EyeMed link: AetnaMedicareVision.com
Dental link: https://shorturl.at/RoEcQ
Nations Hearing: Aetna.Nationsbenefits.com/Hearing
Find A Doc: Aetnamedicare.com/en/find-doctors-hospitals/find-provider.html
Helpful Plan Resources: http://AetnaMedicare.com/H5521-286
Aetna Customer Service: 1-833-570-6670