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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 2026, 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 2026.
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 $60.00. 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 $350.00 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) Medicare plan features a drug deductible of $350. Under this plan, Tier 1 preferred generic drugs are available with no copay for one-, two-, or three-month fills at standard pharmacies and standard mail-order services. Tier 2 generic drugs require a $5 copay for a one-month supply, with three-month supplies costing a $15 copay at standard pharmacies or a reduced $10 copay through standard mail order. For brand-name and specialty medications, cost-sharing is based on a percentage of the drug cost. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs carry a 40% coinsurance for standard retail and mail-order fills. Tier 5 specialty drugs are covered with a 29% coinsurance for a one-month supply.
Additional Benefits
The eternalHealth Give Back (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care, specialist visits, telehealth, and home health services. For inpatient hospital stays, members pay a $390 daily copay for the first six days and no copay for days seven through ninety, while outpatient hospital services range from no copay to a $350 copay. Emergency care is available with a $100 copay, which is waived if admitted, and urgent care copays range from no copay to $25. Ancillary benefits include dental coverage up to a $2,000 annual limit with no copay or coinsurance for most preventive and comprehensive treatments. Vision care features a $35 routine exam copay and up to $200 annually for eyewear with no copay, while hearing aids require copays between $595 and $895. Additionally, members can access covered preventive services, a meal benefit for chronic illnesses, and an over-the-counter benefit of up to $45 every three months with no copay or coinsurance.
Inpatient Hospital See details
eternalHealth Give Back (PPO) covers inpatient hospital services with no coinsurance, requiring a $390 daily copay for days 1 through 6 and no copay for days 7 through 90 per stay. This benefit is partially covered because psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered, though acute care offers unlimited additional days.
Outpatient Services See details
Outpatient services under the eternalHealth Give Back (PPO) are covered with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
eternalHealth Give Back (PPO) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
eternalHealth Give Back (PPO) covers ground and air ambulance services with a $300 copay (waived if admitted to the hospital) and no coinsurance, subject to prior authorization. Transportation services are partially covered, providing up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
eternalHealth Give Back (PPO) covers emergency services with a $100 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no coinsurance and a copay ranging from no copay to $25, while worldwide emergency care is covered up to $25,000 with no coinsurance and copays ranging from no copay to $300.
Primary Care See details
eternalHealth Give Back (PPO) offers primary care, specialist, and telehealth services with no copay and no coinsurance, while physical, speech, and occupational therapies have a $30 copay and no coinsurance. For chiropractic care, some services are covered with a $15 copay and no coinsurance, but routine chiropractic care and other chiropractic services are not covered, and podiatry services are also not covered.
Preventive Services See details
Preventive services are partially covered by eternalHealth Give Back (PPO) with no copay and no coinsurance for covered services like annual physicals, fitness benefits, and kidney disease education. Uncovered sub-services include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered under the eternalHealth Give Back (PPO) plan, which features routine hearing exams for a $35 copay and no coinsurance, plus unlimited fitting evaluations. Prescription hearing aids are covered with a copay ranging from $595 to $895 and no coinsurance, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
eternalHealth Give Back (PPO) partially covers vision services with no deductibles, offering one routine eye exam per year for a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered with no copay or coinsurance up to a $200 annual limit for contact lenses or one pair of eyeglasses, though upgrades are not covered.
Dental Services See details
eternalHealth Give Back (PPO) partially covers dental services up to a $2,000 annual limit for both in- and out-of-network care, featuring no copay and no coinsurance for most preventive and comprehensive treatments. Medicare-covered dental services have a $35 copay and no coinsurance, while adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the eternalHealth Give Back (PPO) with no copay, although prior authorization is required. Covered Medicare Part B drugs, such as chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin services also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by the eternalHealth Give Back (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by eternalHealth Give Back (PPO) with no copays, although prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies range from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by eternalHealth Give Back (PPO) with no coinsurance, though prior authorization is required. Diagnostic tests and procedures have a $0 to $20 copay, lab services have no copay, and radiological services require copays of $20 for X-rays, at least $60 for therapeutic radiology, and at least $80 for diagnostic radiology.
Home Health Services See details
Home health services are covered under the eternalHealth Give Back (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered by the eternalHealth Give Back (PPO) plan, which covers only additional cardiac rehabilitation services with a $25 copay and no coinsurance. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
eternalHealth Give Back (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $203 daily copay for days 21 through 100. Prior authorization is required and a 3-day prior hospital stay is not needed, though additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
eternalHealth Give Back (PPO) provides partially covered other services, including a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $45 every three months via reimbursement, and the meal benefit is available for chronic illnesses.
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