Aetna Medicare Eagle (PPO) Medicare Advantage Plan H5521-369 • 2026 • Santa Clara County, CA

Aetna Medicare Eagle Overview

Plan Details for Aetna Medicare Eagle

This Medicare Advantage Preferred Provider Organization (PPO) plan provides access to Medicare-approved providers and covers Medicare Part A and Part B services. The monthly premium is $0.00, with lower costs when using in-network providers.

Primary care visits have a $0 copay | Out-of-network: 50% coinsurance, specialist visits come with a $40 copay | Out-of-network: 50% coinsurance, urgent care services carry a $40 copay, and ambulance transportation is $265 copay | Out-of-network: $265 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6750.00. Once this limit is reached, in-network services are fully covered.

This plan is listed by CMS under Plan ID H5521-369. Cost-sharing details for key services are provided below.

Out-of-Pocket Costs

Aetna Medicare Eagle has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5521-369.

Certain preventive services are covered 100% by Aetna Medicare Eagle as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

Medicare Plan Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.