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eternalHealth Give Back (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for eternalHealth Give Back (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on eternalHealth Give Back (PPO) in 2025, please refer to our full plan details page.
eternalHealth Give Back (PPO) is a PPO plan offered by Eternal Health of Delaware, Inc. available for enrollment in 2025 to people living in Bris, Middle, Nor, Ply, Suff & Wor. The overall rating for this plan is not yet available for 2025.
It's important to know that eternalHealth Give Back (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about eternalHealth Give Back (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For eternalHealth Give Back (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $70.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The eternalHealth Give Back (PPO) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. For preferred brand and non-preferred drugs, you will pay 29% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The eternalHealth Give Back (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services. Many services have no copay, but some services have copays, such as inpatient hospital stays, emergency services, and specialist visits. This plan provides coverage for ambulance, emergency, and transportation services, with copays depending on the service. Additionally, the plan covers services like home health, skilled nursing, and home infusion with specific cost-sharing arrangements. Other benefits include coverage for durable medical equipment, diagnostic and radiological services, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $395 copay, and for days 6-90, there is no copay; additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $350, and observation services with a $350 copay. Additionally, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $25 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the eternalHealth Give Back (PPO) plan, including both ground and air ambulance services. Ground and air ambulance services have a $300 copay, but there is no coinsurance. Transportation services to a plan-approved health-related location are covered, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the eternalHealth Give Back (PPO) plan. Emergency Services have a $100 copay with no coinsurance, and the copay is waived if admitted to the hospital within 24 hours; Urgently Needed Services have a copay between $0 and $25 with no coinsurance; Worldwide Emergency Coverage has a $100 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $300 copay, all with no coinsurance, and a maximum plan benefit of $25,000.
Primary Care See details
The eternalHealth Give Back (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services and physical therapy have a $20 copay, while mental health specialty services and psychiatric services have a copay between $0 and $25. Other Health Care Professional services have a copay between $0 and $35, and opioid treatment program services have a $45 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The eternalHealth Give Back (PPO) plan covers a variety of preventive services, including annual physical exams, kidney disease education services, and other preventive services. Additional preventive services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered, with a minimum copay of $595 and a maximum copay of $895 for 2 visits per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision Services includes coverage for eye exams with a $25 copay, and eyewear with a combined maximum benefit of $200 every year. Contact lenses and eyeglasses (lenses and frames) are covered, while upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $45 copay, as well as other dental services with a $2,500 annual maximum benefit. The plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the eternalHealth Give Back (PPO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the eternalHealth Give Back (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the eternalHealth Give Back (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have between 0% and 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, and lab services, are covered under the eternalHealth Give Back (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300 with a minimum copay of $150, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the eternalHealth Give Back (PPO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the eternalHealth Give Back (PPO) plan. Although Cardiac Rehabilitation Services are technically covered, the plan does not cover the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the eternalHealth Give Back (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the eternalHealth Give Back (PPO) plan, Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-Counter (OTC) Items are covered up to $45 every three months, and Meal Benefits are covered for a chronic illness.
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