Aetna Medicare Eagle Plan (PPO)

What Is the Eagle PPO?

The Aetna Medicare Eagle Plan (PPO) is a Medicare Advantage (Part C) offering that combines the flexibility of a preferredprovider organization with the comprehensive coverage of Medicare. It is designed for people who want to keep the freedom to see any doctor or specialistwhether innetwork or outofnetworkwhile still enjoying the costsaving advantages of a managedcare plan.

Who Is Eligible?

To qualify for the Eagle PPO you must:

• Be enrolled in Original Medicare (Part A & Part B).
• Live in a state where the Eagle PPO is offered (check Aetnas state list).
• Not be enrolled in any other Medicare Advantage plan.
• Not have endstage renal disease (ESRD), unless the plan specifically allows it.

Key Benefits & Coverage

The Eagle PPO bundles the standard Medicare benefits with several additional services:

• Hospital and Medical Coverage Same as Original Medicare, with lower coinsurance when using innetwork providers.
• Prescription Drug Coverage (Part D) Included, with a tiered formulary and preferred pharmacy network.
• OutofNetwork Flexibility You may see doctors outside the network for a higher cost share.
• Preventive Care Annual wellness visits, screenings, flu shots, and vaccinations at no cost.
• Dental, Vision, & Hearing Routine cleanings, eye exams, glasses, and hearing aid discounts are often covered.
• Wellness Programs Access to fitness discounts, telehealth, and chroniccondition management.
• Transportation Nonemergency medical transportation to appointments in many regions.

Costs & OutofPocket Limits

While costs vary by county, the typical structure includes:

• Monthly Premium $0 to $35 (some counties have a $0 premium if you qualify for a $0premium Medicare Advantage plan).
• Annual Deductible $0 for innetwork services; a small deductible may apply for outofnetwork care.
• Copay/Coinsurance $20$40 for primary care visits, $40$80 for specialist visits, 20% after the deductible for outofnetwork services.
• Prescription Drug Cost Tierbased copays ranging from $5 for generics to $60+ for specialty drugs.
• Maximum OutofPocket (MOOP) $6,700 in 2024 (federal limit for Medicare Advantage). Once you hit this amount, the plan covers 100% of additional costs.

All costs are subject to change each plan year, so review the Summary of Benefits for your specific county.

How to Enroll

1. Visit the Aetna Medicare website and use the plan finder tool.
2. Enter your ZIP code to confirm availability and see the exact premium and deductible for your location.
3. Compare the Eagle PPO with other Aetna and nonAetna Medicare Advantage options.
4. Choose the Eagle PPO and click Enroll Now. Youll need your Medicare card number and personal identification.
5. Submit the application online, by phone, or with a paper enrollment form.
6. If you already have a Medicare Advantage plan, you can switch during the Annual Election Period (Oct15Dec7) or during a Special Enrollment Period if you qualify.

How It Compares to Other Medicare Options

Original Medicare + Medigap

• Offers unlimited choice of doctors but typically higher outofpocket costs.
• Does not include prescription drug coverage or extra benefits such as dental or vision.

Other Medicare Advantage PPOs

• Many have similar outofnetwork flexibility, but the Eagle PPO often stands out for its robust wellness programs and lower MOOP.
• Planspecific pharmacy formularies and network sizes can differ, so compare drug tiers and provider lists.

Medicare Advantage HMO

• Lower premiums and usually lower copays, but you must use innetwork doctors (except for emergencies).
• The Eagle PPO is a better fit for beneficiaries who travel frequently or have established relationships with outofnetwork specialists.

Tips for Getting the Most Out of Your Eagle PPO

• Use InNetwork Providers whenever possible to keep costs down.
• Check the Drug Formulary each year; a change can affect your outofpocket spend.
• Take Advantage of Preventive Servicestheyre covered at no cost and can catch issues early.
• Enroll in Wellness Programs such as fitness memberships or telehealth visits to reduce overall health expenses.
• Review Your MOOP periodically; if you approach the limit, plan ahead for any needed procedures.
• Keep Your Medicare Card Handy when you travel; the Eagle PPOs outofnetwork coverage can be a lifesaver.

Choosing a Medicare Advantage plan is an important decision that affects both your health care experience and your budget. The Aetna Medicare Eagle Plan (PPO) offers a blend of flexibility, comprehensive coverage, and added wellness perks that can make it a strong choice for many seniors. Review the details each year, compare with other options, and select the plan that aligns best with your health needs and lifestyle.