Aetna Medicare Eagle (PPO) H5521-286-000 2023 Plan Details and Costs

Indiana, Michigan, Wisconsin and Illinois 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 Indiana, Michigan, Wisconsin and Illinois Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

H5521-286 Aetna Plan Details:

This H5521-286 plan is a Medicare Advantage special needs plan offered by Aetna with the Plan ID: H5521-286-000. This plan offers all the same benefits of Medicare Plan A and Plan B as well as additional benefits that gives you more coverage. Because of this some of the out-of-pocket costs and coverage might be different, so we've broken down all the details of this plan below!

H5521-286 Aetna Plan

Plan ID: H5521-286-000

Aetna Medicare Advantage Plan is coordinated care Medicare Advantage plan offered by Aetna for beneficiaries in Indiana, Michigan, Wisconsin and Illinois. Below you will find more details on coverage, costs, and specific plan data for the H5521-286-000 plan.

Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	($1.00)
Out-of-pocket maximum	$4,390.00
Initial drug coverage limit	$0.00
Catastrophic drug coverage limit	$7,400.00
Primary care doctor visit	$0 in-network / $25 out-of-network
Specialty doctor visit	$35 in-network / $55 out-of-network
Inpatient hospital care	$275 per day, days 1-7; $0 per day, days 8-90 in-network / 50% per stay out-of-network
Urgent care	Urgent Care: Copayment for Urgent Care $45.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $100.00
Emergency room visit	$100 If you are admitted to the hospital within 0 hours your cost share may be waived, for more information see the Evidence of Coverage
Ambulance transportation	$290 in-network / $290 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Eagle (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Eagle (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage	Details
Chiropractic services	Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 50%
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/ $30 out-of-network, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $75 in-network/ 50% out-of-network, for more information see Evidence of Coverage Imaging: Xray: $20 in-network / CT Scans: $250 in-network / Diagnostic Radiology other than CT Scans: $250 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 / 50% out-of-network
Mental health inpatient care	Out-of-Network: Coinsurance for Psychiatric Hospital Services per Stay 50%
Mental health outpatient care	Mental Health - Group Sessions: $40 in-network/ Mental Health - Individual Sessions: $40 in-network/ 50% out-of-network, for more information see Evidence of Coverage Psychiatric Services - Group Sessions: $40 in-network/ Psychiatric Services - Individual Sessions: $40 in-network/ 50% out-of-network, for more information see Evidence of Coverage
Outpatient services/surgery	Ambulatory Surgical Center: $350 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network / 50% out-of-network, for more information see Evidence of Coverage
Outpatient substance abuse care	In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $40.00 Copayment for Medicare-covered Group Sessions $40.00 Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter items	$120 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry services	Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $55.00
Skilled Nursing Facility (SNF) care	$0 per day, days 1-20; $184 per day, days 21-100 in-network/ 45% per stay out-of-network, for more information see Evidence of Coverage

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Dental care	$3,000 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage.

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Vision benefits	$300 reimbursement every year, for more information see the Evidence of Coverage

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Hearing benefits	$1,500 per ear every year, for more information see the Evidence of Coverage

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Preventive services and health/wellness education programs	$0 copay for all preventive services covered under Original Medicare at zero cost sharing

When reviewing Indiana, Michigan, Wisconsin and Illinois 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 Indiana, Michigan, Wisconsin and Illinois 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.

Plan Documents

Links to plan documents	Summary of benefits Star ratings

Links to plan documents

Indiana Counties Served

Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clay Clinton Daviess Dekalb Delaware Elkhart Fountain Fulton Gibson Grant Greene Hamilton Hancock Hendricks Henry Howard Huntington Jackson Jasper Jay Jennings Johnson Knox Kosciusko La Porte Lagrange Lake Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Owen Parke Pike Porter Posey Pulaski Putnam Randolph Shelby St Joseph Starke Steuben Sullivan Tippecanoe Tipton Vanderburgh Vermillion Vigo Wabash Warren Warrick Wayne Wells White Whitley

Michigan Counties Served

Alcona Alger Allegan Alpena Antrim Arenac Baraga Bay Benzie Berrien Branch Calhoun Cass Charlevoix Cheboygan Chippewa Clare Clinton Crawford Delta Dickinson Eaton Emmet Genesee Gladwin Grand Traverse Gratiot Hillsdale Houghton Huron Ingham Iosco Iron Isabella Jackson Kalamazoo Kalkaska Kent Keweenaw Lake Lapeer Leelanau Lenawee Livingston Luce Mackinac Macomb Manistee Marquette Menominee Midland Missaukee Monroe Montcalm Montmorency Muskegon Oakland Oceana Ogemaw Ontonagon Oscoda Otsego Ottawa Presque Isle Roscommon Saginaw Saint Clair Saint Joseph Sanilac Schoolcraft Shiawassee Tuscola Washtenaw Wayne Wexford

Wisconsin Counties Served

Illinois Counties Served

Enrolling in H5521-286-000 Medicare Advantage Plans in Indiana, Michigan, Wisconsin and Illinois

Medicare beneficiaries from Indiana, Michigan, Wisconsin and Illinois may have access to Medicare Advantage plans from Aetna and other insurance companies.

Get help comparing your local plan options by calling to speak with a licensed insurance agent who can help you find out if your doctor and prescription drugs are covered by a Medicare Advantage plan in your area.