Aetna Medicare Eagle (PPO)
South Dakota Medicare Advantage Plan (2023 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
3.5Ready to Enroll Online?
Plan Overview
Aetna Medicare Eagle (PPO) is a Medicare Advantage Plan Without Prescription Drugs, which is available in South Dakota and offered by the health insurance company Aetna Medicare. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Aetna Medicare Eagle (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $10,000 In and Out-of-network $6,700 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Aetna Medicare Eagle (PPO) are defined below.
Additional Benefits and Coverage
Aetna Medicare Eagle (PPO) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Aetna Medicare Eagle (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Aetna Medicare Eagle (PPO) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of Aetna Medicare Eagle (PPO) to Other Plans in South Dakota
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2023, Aetna Medicare Eagle (PPO) received an overall government quality rating of 3.5 stars out of 5 stars.
Aetna Medicare Eagle (PPO) performed worse than South Dakota’s State average overall quality score of 4.1 stars.
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Aetna Medicare Eagle (PPO) received 3.5 stars for its health plan quality score which is worse than the South Dakota State average health plan quality score of 4.1 stars.
Plan Benefits and Coverage Details
$6,700 In-network
Medical Benefits
Doctor Services
Out-of-network: 50% coinsurance per visit
Out-of-network: 50% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Hospital Services
$0 per day for days 8 through 90
Out-of-network: 50% per stay
Out-of-network: 50% coinsurance per visit
Skilled nursing facility
$184 per day for days 21 through 100
Out-of-network: 50% per stay
Preventive services
Out-of-network: 0-50% coinsurance
Ambulance
Out-of-network: $320 copay
Therapy services
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Mental health services
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Opioid treatment services
Other services
Out-of-network: 50% coinsurance per item
Out-of-network: 50% 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
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Extra Benefits
Hearing
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: $0 copay
Preventive Dental
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Comprehensive dental
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Vision
Out-of-network: 50% coinsurance
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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