Aetna Medicare Eagle Giveback (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H1608-074-000
Arkansas Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about Arkansas Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
|Monthly plan premium||$0.00|
|Initial drug coverage limit||$0.00|
|Catastrophic drug coverage limit||$8,000.00|
|Primary care doctor visit||$0 in-network | $25 out-of-network|
|Specialty doctor visit||$30 in-network | 50% out-of-network|
|Inpatient hospital care||$455 per day, days 1-5; $0 per day, days 6-90 in-network | 35% per stay out-of-network|
Copayment for Urgent Care $35.00
Copayment for Worldwide Urgent Coverage $100.00
Maximum Plan Benefit of $250000.00
|Emergency room visit||$100 If you are admitted to the hospital within 24 hours your cost share may be waived, for more information see the Evidence of Coverage|
|Ambulance transportation||$265 in-network | $265 out-of-network|
Aetna Medicare Eagle Giveback (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Eagle Giveback (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
Coinsurance for Medicare Covered Chiropractic Services 20%
|Diabetes supplies, training, nutrition therapy and monitoring||0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.|
|Durable medical equipment (DME)||20% in-network | 25% out-of-network|
|Diagnostic tests, lab and radiology services, and X-rays||Lab Services: Lab Services: $0 in-network| 35% out-of-network, for more information see Evidence of Coverage|
Diagnostic Procedures: Diagnostic Procedures/Tests: $0 for services provided by your primary care physician in their office in-network; $50 for services performed by a provider other than your primary care physician| 50% out-of-network, for more information see Evidence of Coverage
Imaging: Xray: $0 for services provided by your primary care physician in their office in-network; $40 for services performed by a provider other than your primary care physician in-network | $40 out-of-network | CT Scans: $275 in-network | Diagnostic Radiology other than CT Scans: $275 in-network | Diagnostic Radiology Mammogram: $0 in-network | 50% out-of-network, for more information see Evidence of Coverage
|Home health care||$0 in-network | 35% out-of-network|
|Mental health inpatient care|
Coinsurance for Psychiatric Hospital Services per Stay 35%
|Mental health outpatient care||Mental Health - Group Sessions: $30 in-network| Mental Health - Individual Sessions: $30 in-network| 50% out-of-network, for more information see Evidence of Coverage |Psychiatric Services - Group Sessions: $30 in-network| Psychiatric Services - Individual Sessions: $30 in-network| 50% out-of-network, for more information see Evidence of Coverage|
|Outpatient services/surgery||Ambulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy | $195 All other in network ASC services | $495 out-of-network, for more information see Evidence of Coverage|
|Outpatient substance abuse care|
Outpatient Substance Abuse Services:
Coinsurance for Medicare Covered Individual or Group Sessions 35%
|Over-the-counter items||In Network: |Over-the-counter (OTC) items:|$150 quarterly amount (allowance) to purchase approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers and more. Approved items can be purchased online, in store, or by phone. |Be sure to use the full benefit amount quarterly, because any unused amount will not rollover.|Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit, for more information see Evidence of Coverage|
Copayment for Medicare-Covered Podiatry Services $30.00
|Skilled Nursing Facility (SNF) care||$0 per day, days 1-20; $203 per day, days 21-100 in-network| 35% per stay out-of-network, for more information see Evidence of Coverage|
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Dental care||In Network Dental Coverage|For covered services: ADA recognized dental services are covered excluding only cosmetic services, those considered medical in nature, and administrative changes.|Preventive dental services: |Oral exams: $0 copay |Cleanings: $0 copay |Fluoride treatment: $0 copay |Bitewing x-rays: $0 copay |Comprehensive dental services:|Non-routine services: $0 copay |Diagnostic services: $0 copay |Restorative services: $0 copay |Endodontics: $0 copay |Periodontics: $0 copay |Extractions: $0 copay |Prosthodontics and maxillofacial services: $0 copay |Out Of Network Dental Coverage|Preventive dental services:| $0 copay |Comprehensive dental services:| $0 copay |$2,500 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage.|
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Hearing benefits||In-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $30|Copayment for Routine hearing Exams $0|(Maximum one exam every year)|Copayment for Fitting/Evaluation for Hearing Aid $0|(Maximum one hearing aid fitting/evaluation every year)|Hearing Aids:|Copayment for Hearing Aids $0|(Maximum two hearing aids every year) |Out-of-Network:|Copayment for Medicare Covered Hearing Exams $50|Copayment for Non-Medicare Covered Hearing Exams $50 |Member must purchase hearing aids through NationsHearing|$500 per ear every year, for more information see the Evidence of Coverage|
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Preventive services and health/wellness education programs||$0 copay for all preventive services covered under Original Medicare at zero cost sharing|
When reviewing Arkansas Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Arkansas that offer similar benefits at similar or lower prices than the plan above. Call 1-877-890-1409 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
|Links to plan documents|
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