Aetna Direct Plan FAQs
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Any active or retired federal employee can enroll in the Aetna Direct plan. However, this plan has several advantages for members who have primary coverage through Medicare Part A and B. For example, if you have Medicare primary, we waive the deductible and most medical coinsurance as well as provide reimbursement for part of Medicare Part B premiums.
Aetna Direct plan is a whole new level of value with:
- Low monthly plan premiums – below the federal average
- A Medical Fund to help you pay Medicare Part B premiums ($900 Self Only and $1,800 Self Plus One and or Family) or to use for other out of pocket covered medical expenses like prescriptions.
- Waived deductibles and coinsurance for medical services if Medicare Part A and Part B are primary and your provider accepts Medicare assignment (not required to stay in network).
|Self Plus One||$289.29||$289.29|
With this Plan, in-network preventive care is covered in full. If you're enrolled in Medicare Part A and B and Medicare is primary, we'll waive the deductible and your coinsurance for most medical services. The annual deductible will also be waived for pharmacy benefits, but cost sharing will still apply (even if Medicare parts A and B are primary). If Medicare Part A and B are not primary, then after you have depleted the medical fund and paid the Plan's deductible (In-network: $1,500 for Self Only enrollment and $3,000 for Self Plus One or Family enrollment or Out-of-network: $2,500 for Self Only enrollment and $5,000 for Self Plus One or Family enrollment), we pay benefits under traditional medical coverage. The Plan typically pays 80% for in-network care and 60% for out-of-network care.
The Aetna Direct plan is an excellent plan option for federal retirees who have Medicare Part A and B as their primary coverage. The premiums and out of pocket costs are significantly lower than most other federal plans. With the Aetna Direct plan, you can reimburse your Part B premiums from the Medical Fund in the amounts of $900 Self Only Only or $1,800 for Self Plus One or Family if funds are available. We also waive the deductible and coinsurance for most medical services if Medicare is primary. You will only pay a $5 copay for generic drugs at a retail pharmacy. Active employees are also eligible to enroll but will be responsible for the deductible and coinsurance.
This plan coordinates seamlessly with Medicare so there will be no paperwork for you to fill out or submit. If you are enrolled in the Aetna Direct plan and take Medicare Parts A and B and Medicare is primary, we will waive your deductible and coinsurance for most medical services. You can also use your Medical Fund ($900 Self Only or $1,800 Self Plus One or Family) to reimburse some of your Medicare Part B premiums by submitting proof of payment. When Medicare Part A and Part B are primary, you can see any provider in or out of network. You should ensure that the provider accepts Medicare's assignment. Be sure to tell us if you have Medicare Parts A and B or any other medical coverage.
The Fund ($900 Self Only or $1,800 Self Plus One or Family) is designed to reimburse Medicare Part B premiums. To receive reimbursement, simply submit proof of payment to Aetna. Be aware, the Fund automatically goes to out of pocket costs if you have not yet submitted forms to reimburse Part B premiums.
If you're not enrolled in Medicare Part B or prefer to use the Medical Fund for other expenses, it can be used for other covered services including prescription drugs.
Remaining Medical Fund dollars roll over from year to year as long as you remain in the plan, up to the maximum rollover amount.
To submit your Medicare Part B premium payment for reimbursement from your Medical Fund just go to www.socialsecurity.gov/myaccount and set up an account. From there, you can print a letter that verifies your benefits. And that's what you send us.
Simply mail that letter to Aetna at PO Box 14079, Lexington, KY 40512.
The pharmacy has access to Aetna's claim system and can determine at the point of sale what your cost sharing is for your covered prescription drug. Your share of the cost will be:
- $5 per covered generic formulary drug
- 30% per covered brand name formulary drug up to a $600 maximum
- 50% per covered non-formulary (generic or brand name) drug up to a $600 maximum.
- Specialty drugs are covered at 50% up to a $600 preferred or $1,200 non-preferred maximum.
Yes, Mail-Order Pharmacy is available for maintenance medications. You can get a 90 day supply for just $0 for generic, $60 for brand name formulary and $105 for non-formulary drugs. Go to the Aetna Navigator® secure member website and click on "pharmacy benefits" for details and forms.
When you enroll in the Aetna Direct plan, you have access to valuable online resources.
Aetna Navigator® - Your secure member website that is packed with health and benefits information. When you register, you can print temporary ID cards, check eligibility or claim status, check Fund balances and much more. Here are just a few of the highlights:
- Cost of Care tool and Member Payment Estimator- Provides insight into out of pocket costs for various medical services. If Medicare is your primary coverage, these estimates may not be representative of your actual costs.
- Hospital Comparison Tool – see how hospitals in your area rank by factors important to you.
- Simple Steps To A Healthier Life® Program – assess your potential health risks, develop a personalized action plan for better health, track your progress and participate in wellness programs.
- Personal Health Record - captures important health information in one place, helping you stay healthy with personalized alerts and reminders and allowing you to print and share your health history with your doctors.
- DocFind® online provider directory – lists participating physicians, hospitals and other health care providers. Using participating providers will help you save money. DocFind® also includes important provider credentials like education, board certification and languages spoken.
- Aetna Mobile - Puts Aetna's online features at your fingertips, it allows you to view your member ID card, find a doctor, look up claims, and access your Personal Health Record (PHR). It's available for Android™ and iPhone® mobile devices. Just type Aetna.com into your mobile web browser.
If you are a retiree and would like to enroll in the Aetna Direct plan:
- Call the Office of Personnel Management (OPM) Retirement Information Center at 888-767-6738 (or 1-800-878-5707 for a TDD for the hearing impaired). Retirees in the Washington DC local calling area should dial 202-606-0551 for a TDD for the hearing impaired.
- Send an email to OPM at firstname.lastname@example.org.
- Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available at Enroll Now. Enrollment procedures for active employees vary by agency.
You have several options:
- Review the Federal Plan brochure and other information on this website
- Visit Aetna Navigator® to see the resources and information available to you when you enroll. Enter the following user name and password: User name: federal3 | Password: federal3
- Call Aetna at 855-277-4356
- Chat live with a health plan specialist or schedule an appointment for a one-on one phone consultation
All members have access to Teladoc, a convenient, lower cost alternative to urgent care or the emergency room. Teladoc® lets you speak to a licensed doctor by web, phone or mobile app in under 10 minutes. It's perfect for when you're traveling or when your doctor isn't available. Members simply visit teladoc.com/aetna or call 855-Teladoc to get started.
Teladoc doctors diagnose non-emergency medical problems, like cold & flu, pink eye, skin rash, stress/anxiety, and recommend treatment. They can even call in a prescription to your pharmacy of choice, when necessary. All Teladoc doctors:
- Are U.S. board-certified in internal medicine, family practice, emergency medicine or pediatrics.
- Are U.S. residents and licensed in your state.
- Average 15 years of practice experience.
Please note: Teladoc is not available to all members and operates subject to state regulations. Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna or plans administered by Aetna. For complete descriptions of the limitations of Teladoc services, visit Teladoc.com/Aetna
You must live or work in our service area to enroll in our plan. Return to the homepage to find plans available in your area. Once enrolled in the plan, covered medical services received overseas would be considered out-of-network. See Section 7 of our federal brochure for more information on how to submit overseas claims.
Yes. You get access to great discounts on prescription eyewear, vision services, gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more! Visit aetnafeds.com/perks.php for more information.
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