Federal Retiree Center

Comparing Aetna Direct and Aetna Medicare Advantage

So you’re turning 65 and planning for retirement. Or maybe you’re taking advantage of the opportunity to change your health plan. Either way, you’ll want to learn more about our Aetna® retiree plans. As a federal employee you’re fortunate to have coverage under the Federal Employees Health Benefits (FEHB) Program when you retire.

You’ve worked hard. Now it’s time for you to enjoy your retirement years. Aetna has two plans designed to take care of the whole you – body, mind and spirit. They also work with Medicare and provide you with comprehensive coverage at an affordable price. Aetna’s FEHB health plans feature the same benefits as parts A and B of Original Medicare. And they can help you live life to the fullest.

Aetna Direct

We introduced Aetna Direct in 2015 as a great alternative for federal retirees who felt they were paying too much for their health plan. Not only does the plan offer low premiums, but it provides a fund that will help pay for certain out-of-pocket expenses. These include Part B premiums and prescriptions. Aetna Direct members usually pay $0 for medical services because the deductible and coinsurance are waived when providers accept Medicare. Aetna Direct is not Medicare, but it works seamlessly with Medicare to coordinate your coverage. With Aetna Direct, you get money-saving features — low plan premiums, low out-of-pocket costs and a fund to help pay for prescriptions or Medicare Part B premiums.

Aetna Medicare Advantage

We introduced Aetna Medicare Advantage to federal retirees as a plan option in 2020. It’s the first of its kind offered through FEHB. Aetna Medicare Advantage provides the same coverage as Original Medicare but with extra benefits like $0 deductibles and prescription benefits. You’ll also get access to programs that may help you reach your health goals. These include SilverSneakers® fitness membership and more. This plan lets you use any doctors and hospitals that are licensed to receive Medicare payment and willing to accept your plan. And with the Aetna Medicare Advantage plan, your coverage follows you wherever you travel nationwide.

The Aetna Medicare Advantage Plan will reduce the Part B premium that you pay to the Social Security Administration by $100 per month. If you pay your Part B premium monthly, you’ll see this dollar amount credited in your Social Security check. If you pay your Part B premium quarterly, you’ll see an amount equaling three months’ of reductions credited on your quarterly Part B premium statement. It may take a few months to see these reductions credited to either your Social Security check or premium statement, but you will be reimbursed for any credits you did not receive during this waiting period.

Take a look at the plans side by side

* When Original Medicare is primary and your provider accepts Medicare payments

Table of plan benefits

	Aetna Direct	Aetna Medicare Advantage
Specialist referral?	No	No
National network?	Yes	Yes
Out-of-network coverage?	Yes	Yes**
Deductible?	Waived***	No
Prescription coverage?	Yes	Yes
Basic dental and vision?	No	No
Help to lower Part B premiums?	Yes, a $900 fund	Yes, $1,200 credit
Flat copays for medical care?	Waived copays***	$0 copays

^***When Original Medicare is primary

^**Out-of-network provider must be eligible to accept Medicare payments and the Aetna plan

Ready to enroll?

For both plans:

Step 1

• Enroll online using OPM’s Open Season Online system
• Or call the OPM Retirement Information Center at 1-888-767-6738 (TTY: 771)
• Choose an enrollment code:

  Table of enrollment codes

  Aetna Direct		Aetna Advantage (retirees with Medicare can opt-in to Aetna Medicare Advantage (PPO))
  Enrollment code	Coverage	Enrollment code	Coverage
  N61	Self only	Z24	Self Only
  N63	Self + 1	Z26	Self + 1
  N62	Self & Family	Z25	Self & Family

Enrolling in Aetna Medicare Advantage is a two-step process for retirees with Original Medicare.

Step 2 - Complete the enrollment with Aetna

• Log on to the Aetna retiree benefits website or
• Call the Aetna Retiree Solutions service center at 1-888-767-6738
• Provide Medicare A and B effective dates and Medicare Beneficiary Identifier (MBI)

Visit Aetna Direct or Aetna Medicare Advantage for more information.

Till next time,
Rick

Aetna Medicare is an HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.

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