Aetna Medicare Eagle Giveback (PPO) Medicare Advantage Plan H5521-323 • 2027
CMS Rating:
(4.0 out of 5 stars*)
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- −$100.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 3,988 beneficiaries
Last update:
Aetna Medicare Eagle Giveback (PPO) Introduction
CMS Plan ID H5521-323 identifies Aetna Medicare Eagle Giveback, a Medicare Advantage PPO plan offered by Aetna Medicare. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket.
Plan Benefits
Aetna Medicare Eagle Giveback includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H5521-323.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $25 copay |
In-network: $0 copay Out-of-network: $25 copay |
| Specialist | In-network: $0-$35 copay Out-of-network: 30% coinsurance |
In-network: $0-$35 copay Out-of-network: $55 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0-$40 copay, 20% coinsurance | In-network: $0-$40 copay, 20% coinsurance |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Health education | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$300 copay Out-of-network: 50% coinsurance |
In-network: $0-$300 copay Out-of-network: 50% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: $30 copay |
In-network: $0 copay Out-of-network: $30 copay |
| Outpatient x-rays | In-network: $35 copay Out-of-network: 50% coinsurance |
In-network: $35 copay Out-of-network: 50% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$35 copay Out-of-network: 50% coinsurance |
In-network: $0-$35 copay Out-of-network: 50% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $115 copay | $115 copay |
| Worldwide emergency care | Coming soon | $115 copay |
| Urgent care | $40 copay | $40 copay |
| Inpatient hospital care | In-network: Tier 1 $375 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
In-network: Tier 1 $375 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 50% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 25% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 Out-of-network: 50% 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: $35 copay Out-of-network: 50% coinsurance |
In-network: $35 copay Out-of-network: 50% coinsurance |
| Outpatient group therapy | In-network: $35 copay Out-of-network: 50% coinsurance |
In-network: $35 copay Out-of-network: 50% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $375 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 30% per stay |
In-network: Tier 1 $375 per day for days 1-6 $0 per day for days 7-90 $0 per stay Out-of-network: 50% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $25 copay Out-of-network: 50% coinsurance |
In-network: $40 copay Out-of-network: 50% coinsurance |
| Occupational therapy | In-network: $25 copay Out-of-network: 50% coinsurance |
In-network: $35 copay Out-of-network: 50% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Periodontics | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Endodontics | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Restorative services | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: 20% coinsurance |
In-network: $0 copay Out-of-network: 20% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: $55 copay |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: $55 copay |
| Prescription hearing aids | In-network: $0-$1700 copay Out-of-network: $0-$1700 copay |
In-network: $0-$1700 copay Out-of-network: $0-$1700 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 | In-network: $0 copay Out-of-network: $0 copay |
| 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 Aetna Medicare Eagle Giveback as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H5521)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Aetna Medicare
- Website
- Aetna Medicare Plan Page
- Providers
- Aetna Medicare Providers Page
- Formulary
- Aetna Medicare Formulary Page
- Pharmacy
- Aetna Medicare Pharmacy Page
- New Member Health Plan Help
- (844)509-6254
- New Member Health Plan TTY
- 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
Aetna Medicare Eagle Giveback (H5521-323-0) is available in the following locations:
New York Counties Served
- Albany
- Allegany
- Broome
- Cattaraugus
- Cayuga
- Chautauqua
- Chemung
- Chenango
- Clinton
- Columbia
- Cortland
- Delaware
- Dutchess
- Erie
- Essex
- Franklin
- Fulton
- Genesee
- Greene
- Hamilton
- Herkimer
- Jefferson
- Lewis
- Livingston
- Madison
- Monroe
- Montgomery
- Niagara
- Oneida
- Onondaga
- Ontario
- Orange
- Orleans
- Oswego
- Otsego
- Putnam
- Rensselaer
- Saint Lawrence
- Saratoga
- Schenectady
- Schoharie
- Schuyler
- Seneca
- Steuben
- Sullivan
- Tioga
- Tompkins
- Ulster
- Warren
- Washington
- Wayne
- Wyoming
- Yates
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Aetna Medicare Eagle Giveback (PPO)
How much does plan H5521-323 cost per month?
For 2027, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The 2027 in-network MOOP is $9850.00. Once this limit is reached, covered in-network costs are fully covered.
What is the total enrollment for plan H5521-323?
CMS reports 3,988 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
The plan’s Part D deductible is $0.00, applied to covered prescription drug costs.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Aetna Medicare (official source) | http://www.aetna.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Provenance documentation for this data is maintained under 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.