Aetna Medicare Eagle Giveback (PPO) Medicare Advantage Plan H5521-322 • 2027 • Fairfax City County, VA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6750.00In-network
- Part B Giveback
- −$100.00 reduction
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Fairfax City County, VA
- Local Enrollment
- 0 beneficiaries in Fairfax City County
Aetna Medicare Eagle Giveback (PPO) Introduction
This Medicare Advantage PPO plan, Aetna Medicare Eagle Giveback, is offered by Aetna Medicare and uses a Preferred Provider Organization (PPO) provider network. It comes without prescription drug coverage. For the 2027 plan year, the monthly premium is $0.00, the medical deductible is $0.00, and the in-network maximum out-of-pocket is $6750.00. The plan is identified by CMS Plan ID H5521-322.
Enrollment in this plan requires residence in Fairfax City County, Virginia. CMS enrollment data reports 0 plan members in Fairfax City County. New members can call the plan directly at (844)509-6254 (TTY 711) for assistance.
Compare Similar Plans in Fairfax City County
Compare this plan with the two most-enrolled PPO plans available in Fairfax City County, Virginia. Enrollment is based on CMS local enrollment data.
| Plan Detail | Aetna Medicare Eagle Giveback | Humana Value Choice | Humana Essentials Plus Giveback |
|---|---|---|---|
| CMS Plan ID | H5521-322-0 |
H7617-098-0 |
H7617-100-0 |
| Local Enrollment | 0 | 79 | 67 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $450 |
| Maximum Out-of-Pocket | $6,750.00 | $7,150.00 | $9,850.00 |
| Part B Giveback | −$100.00 reduction | Not offered | −$119.00 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $30 copay | $35 copay | $40 copay |
| Part D Deductible | Not Applicable | $450.00 | $700.00 |
| CMS Star Rating | 4.0 | 4.5 | 4.5 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Fairfax City County, or compare Medicare Advantage plans across Virginia, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
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 H5521-322.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5521-322-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $10 copay - Specialist
- In-network: $30 copay
Out-of-network: $40 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Telehealth benefit
- In-network: $0-$50 copay, 20% coinsurance
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
Out-of-network: $0 copay - Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: $0 copay - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$250 copay
Out-of-network: 20% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: 20% coinsurance - Outpatient x-rays
- In-network: $0-$50 copay
Out-of-network: 20% coinsurance - Diagnostic tests and procedures
- In-network: $0-$30 copay
Out-of-network: 20% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $40 copay
- Inpatient hospital care
- In-network:
Tier 1
$334 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$10 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
50% per stay - Ground ambulance
- In-network: $275 copay
Out-of-network: $275 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $10 copay
Out-of-network: 20% coinsurance - Outpatient group therapy
- In-network: $10 copay
Out-of-network: 20% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$334 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $20 copay
Out-of-network: $40 copay - Occupational therapy
- In-network: $20 copay
Out-of-network: 20% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- 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
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 50% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 50% coinsurance - Periodontics
- In-network: 20%-50% coinsurance
Out-of-network: 50%-70% coinsurance - Endodontics
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance - Restorative services
- In-network: 20%-50% coinsurance
Out-of-network: 50%-70% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 20%-50% coinsurance
Out-of-network: 50%-70% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $0 copay - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglass frames only
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglass lenses only
- In-network: $0 copay
Out-of-network: $0 copay - Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay - Upgrades
- In-network: $0 copay
Out-of-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: $40 copay - Fitting/evaluation
- In-network: $0 copay
Out-of-network: $40 copay - Prescription hearing aids
- In-network: $0 copay
Out-of-network: $0 copay - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- 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)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| 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.
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 | Compare types of 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.