Aetna Medicare Eagle (PPO)
Aetna Medicare · PPO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $6,750
- Higher than most plans here
- Drug coverage
- Not included
- You would need a separate drug plan
- Medicare star rating
- 4.5 of 5
In plain English
Compared with the 28 other plans in San Francisco County that the same person could join.
What stands out
- No monthly premium
- Dental: plan pays up to $3,000 a year, tied for most here
- Dental, vision and hearing extras included
Watch out for
- Up to $6,750 a year for covered care, higher than most plans here
- $1,720 for a 5-day hospital stay, higher than most plans here
- $40 for specialist visits, higher than most plans here
- $40 for urgent care, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$200$0 in premiums + $200 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$2,895$0 in premiums + $2,895 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$40Higher than most plans here
- Urgent care$40Higher than most plans here
- Emergency room$130Not charged if you stay in the hospital within 24 hours
- Hospital stay$430 a day for days 1 to 4, then $0 for days 5 to 90Higher than most plans herePlan approval may be needed
- Lab tests$0Plan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0 to $275Depends on the servicePlan approval may be needed
- Outpatient hospital care$0 to $350Depends on the service
- X-rays$0Plan approval may be needed
- MRI, CT and other scans$0 to $150Depends on the servicePlan approval may be needed
- Ground ambulance$265Plan approval may be needed
- Skilled nursing facility$10 a day for days 1 to 20, then $218 a day for days 21 to 100Plan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 28 other plans in San Francisco County that the same person could join. Read the plan’s 2026 booklet (PDF)
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay 20% to 50%.Plan pays up to $3,000 a year.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eye exams: plan pays up to $50 a year. Eyewear: plan pays up to $500 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $1,500 a year per ear.
- Over-the-counter items IncludedUp to $75 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Aetna Medicare Eagle (PPO), plan number H5521-369, for 2026?”