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 9 other plans in San Luis Obispo County that the same person could join.
What stands out
- No monthly premium
- Dental: plan pays up to $3,000 a year, most of 5 plans 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 care4 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 9 other plans in San Luis Obispo 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?”