Aetna Medicare Eagle (PPO)
Medicare Plan Details
2022 Plan
Monthly Premium
| (select county for price) |
by Aetna Medicare
Additional Coverage
HearingVisionDental
Overall Government Star Rating
4.5out of 5 stars
State: Indiana
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B
Plan Details
$0
$0
$0
$0
$8,000 In and Out-of-network
$5,500 In-network
$5,500 In-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
In-network: $0 copay
Out-of-network: $25 copay per visit
Out-of-network: $25 copay per visit
In-network: $35 copay per visit
Out-of-network: $55 copay per visit
Out-of-network: $55 copay per visit
Tests, labs, & imaging
In-network: $0-75 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $0 copay
Out-of-network: $30 copay
Out-of-network: $30 copay
In-network: $0-250 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $20 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
$90 copay per visit (always covered)
$45 copay per visit (always covered)
Hospital Services
In-network: $290 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-network: 50% per stay
$0 per day for days 8 through 90
Out-of-network: 50% per stay
In-network: $0-350 copay per visit
Out-of-network: 50% coinsurance per visit
Out-of-network: 50% coinsurance per visit
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-network: 45% per stay
$184 per day for days 21 through 100
Out-of-network: 45% per stay
Preventive services
In-network: $0 copay
Out-of-network: 0-50% coinsurance
Out-of-network: 0-50% coinsurance
Ambulance
In-network: $290 copay
Out-of-network: $290 copay
Out-of-network: $290 copay
Therapy services
In-network: $40 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Mental health services
In-network: $40 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Opioid treatment services
Covered
Other services
In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item
Out-of-network: 25% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item
Out-of-network: 50% coinsurance per item
In-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Part B Drugs
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Extra Benefits
Hearing
In-network: $0 copay
Out-of-network: $55 copay
Out-of-network: $55 copay
In-network: $0 copay
Out-of-network: $55 copay
Out-of-network: $55 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Preventive Dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
In-network: $0 copay
Out-of-network: $55 copay
Out-of-network: $55 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
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