EternalHealth Give Back (PPO) Medicare Advantage Plan H2694-002 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6500.00In-network
- Part B Giveback
- −$48.00 reduction
- Prescription Coverage
- Enhanced, $400.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 2,606 beneficiaries
EternalHealth Give Back (PPO) Introduction
CMS Plan ID H2694-002 identifies EternalHealth Give Back, a Medicare Advantage PPO plan offered by eternalHealth. The plan uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $6500.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $400.00.
Plan Benefits
EternalHealth Give Back has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H2694-002.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Specialist | In-network: $10 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $20 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health education | Not covered | Not covered |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $80-$300 copay Out-of-network: 30% coinsurance |
In-network: $80-$300 copay Out-of-network: 20% coinsurance |
| Lab services | In-network: $0-$20 copay Out-of-network: 30% coinsurance |
In-network: $0-$20 copay Out-of-network: 20% coinsurance |
| Outpatient x-rays | In-network: $20 copay Out-of-network: 30% coinsurance |
In-network: $20 copay Out-of-network: 20% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$20 copay Out-of-network: 30% coinsurance |
In-network: $0-$20 copay Out-of-network: 20% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $130 copay | $100 copay |
| Worldwide emergency care | Coming soon | $100 copay |
| Urgent care | $25 copay | $0-$25 copay |
| Inpatient hospital care | In-network: Tier 1 $435 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: 45% per stay |
In-network: Tier 1 $390 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $203 per day for days 21-100 Out-of-network: 30% per stay |
In-network: Tier 1 $0 per day for days 1-20 $203 per day for days 21-100 Out-of-network: 30% per stay |
| Ground ambulance | In-network: $300 copay Out-of-network: $300 copay |
In-network: $300 copay Out-of-network: $300 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0-$30 copay Out-of-network: $50 copay |
In-network: $0-$30 copay Out-of-network: $50 copay |
| Outpatient group therapy | In-network: $0-$30 copay Out-of-network: $50 copay |
In-network: $0-$30 copay Out-of-network: $50 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $435 per day for days 1-7 $0 per day for days 8-90 $0 per stay Out-of-network: 45% per stay |
In-network: Tier 1 $390 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $30 copay Out-of-network: $50 copay |
In-network: $30 copay Out-of-network: $50 copay |
| Occupational therapy | In-network: $30 copay Out-of-network: $50 copay |
In-network: $30 copay Out-of-network: $50 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 20% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Implant services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids | In-network: $595-$895 copay Out-of-network: 80% coinsurance |
In-network: $595-$895 copay Out-of-network: $595-$895 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by EternalHealth Give Back as a Part B benefit.
Prescription Drug Coverage
EternalHealth Give Back includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($7.20) |
| Supplemental Part D Premium: | $$7.20 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $33.82 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $400.00 annual Part D deductible. You'll pay this deductible at the pharmacy before eternalHealth starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, EternalHealth Give Back may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 35% coinsurance | Coming soon |
| Specialty Tier | 28% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H2694)
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.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | Not enough data available |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for eternalHealth
- Website
- eternalHealth Plan Page
- Providers
- eternalHealth Providers Page
- Formulary
- eternalHealth Formulary Page
- Pharmacy
- eternalHealth Pharmacy Page
- New Member Health Plan Help
- (833)870-3443
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)870-3443
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
EternalHealth Give Back (H2694-002-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About EternalHealth Give Back (PPO)
How much does plan H2694-002 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $6500.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for EternalHealth Give Back?
The 2027 CMS star rating for EternalHealth Give Back is ★2.5 out of 5.
What is the current enrollment for EternalHealth Give Back?
The plan has 2,606 enrolled beneficiaries according to CMS.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $400.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| eternalHealth (official source) | https://www.eternalhealth.com/ | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.