About the Plan
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At Aetna®, we take a total approach to health and wellness, so you can age actively. The Aetna Advantage plan allows you to opt in to the Aetna Medicare Advantage plan offered through the Federal Employees Health Benefits (FEHB) program. It’s a nationwide plan that provides value to federal retirees, with Medicare Parts A and B, by offering $0 deductibles, prescription drug coverage and a credit to reduce your Medicare Part B premium. It also provides access to additional programs like Healthy Home Visits, meals after an inpatient hospital stay, transportation to medical appointments and a SilverSneakers® fitness membership at no additional cost.
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Federal retirees with Medicare Parts A and B will continue to pay Part B premiums. You’ll enroll in the Aetna Advantage plan then opt in to the Aetna Medicare Advantage plan. It provides the same coverage as Original Medicare but with additional benefits you wouldn’t get, such as $0 deductibles and prescription benefits. You’ll also get access to programs that can help you reach your health potential, including a SilverSneakers fitness membership, hearing aid reimbursement and more.
Opting in to the Aetna Medicare Advantage plan does not change your FEHB premium nor your enrollment code. Only retirees with Medicare Parts A and B may elect to opt in to the Aetna Medicare Advantage plan by following a two-step enrollment process.
The plan also includes a $1,200 annual ($100/month) Medicare Part B premium reduction.
You can see any provider who accepts Medicare and the Aetna plan.
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Aetna Medicare Advantage is a great plan for federal retirees who are looking for a plan to help them on their health journey — body, mind and spirit. Members who have Medicare Parts A and B as their primary coverage will have $0 deductible, low prescription costs and a way to help lower Medicare Part B premiums. Some of the special programs included with the Aetna Medicare Advantage plan are Healthy Home Visits, meals after an inpatient hospital stay, transportation to medical appointments and a SilverSneakers® fitness membership at no additional cost.
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These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to the FEHB program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
Premiums for the Aetna Advantage Plan: Monthly rates Enrollment code Non-postal Self only Z24 $125.00 Self plus one Z26 $275.00 Self plus family Z25 $331.25 -
No, this Aetna Medicare Advantage plan is a special offering available to you if you enroll in Aetna Advantage through the FEHB program and have Medicare Parts A and B. You do not suspend your FEHB plan.
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You will initially receive an ID card as a member of Aetna Advantage. After you complete the two-step enrollment process, you will receive a second ID card which indicates you are in our Medicare Advantage PPO plan. You should always present the Aetna Medicare Advantage PPO card when asked for insurance information.
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You have several options:
- Chat live with a health plan specialist or schedule a one-on-one appointment at AetnaFedsLive.com
- Visit AetnaFeds.com/Advantage
- Review the Federal Plan brochure and other information on this website
- Call Aetna® at 1-855-277-4356 (TTY:711) Monday through Friday, 8 AM to 6 PM in all time zones.
Enrollment
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All eligible federal retirees and their dependents with Medicare Parts A and B primary. Other eligible federal employees are able to enroll in Aetna Advantage; however, without Medicare Parts A and B as primary, deductibles and coinsurance will apply and you will be unable to opt in to Aetna Medicare Advantage. You must also live or work in our service area to enroll.
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It requires two easy steps for retirees with Medicare Parts A and B:
Step 1: Enroll as you normally would through the OPM Retirement website RetireeFEHB.OPM.gov. Or you can call 1-888-767-6738 (TTY: 1-800-878-5707), Monday through Friday, 8 AM to 6 PM in all time zones. Enroll in Aetna Advantage using enrollment code Z24 for Self Only, Z26 for Self plus one or Z25 for Self and Family coverage.
Step 2: Provide Aetna with your Medicare information. Once you’re enrolled through the OPM Retirement website, your basic information will be transferred to Aetna. (Please allow 7–10 business days.) In addition, to opt in to Aetna Medicare Advantage we will need the following:
- Your original Medicare effective date for Parts A and B
- Your Medicare Beneficiary ID
You can provide us this information by visiting AetnaRetireeHealth.com/FEHBP or calling Aetna at 1-866-241-0262 (TTY: 711), Monday through Friday, 8 AM to 8 PM ET.
If you’re not retired, you’ll need to use your agency’s enrollment process. Detailed instructions and information are available on this website under Enroll Now.
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Once you’re enrolled in Aetna Advantage through OPM, providing us with your Medicare information will allow us to enroll you in the Aetna Medicare Advantage plan. Aetna Medicare Advantage is a Medicare Part C plan. Per CMS guidelines, we need your Medicare information to complete your enrollment.
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Coverage and 2024 benefit changes for current members and annuitants begins on January 1, 2024. Coverage for new Aetna members who are actively employed joining during Open Season becomes effective on the first day of the first pay period in January 2024.
If you enroll as a newly hired Federal Employee, you have 60 days to enroll in an FEHB plan. Your enrollment will become effective the beginning of the pay period after your enrollment is received.
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If you do not receive your ID card by your effective date, you may use a copy of your electronic enrollment confirmation. If you are enrolled in our system, you may register on your member website and print an ID card. After you register, simply select "ID card" and follow the instructions. You can use this printable version of your personal ID card if you need medical care.
Doctors and networks
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No, with the Aetna Medicare Advantage plan, the provider must accept Medicare payment and the Aetna plan. There’s a good chance you may be able to continue seeing your current health care providers.
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You can search for providers who accept Medicare payment on Medicare's website. Just visit Medicare.gov/PhysicianCompare to search near you. You can filter provider results by distance, gender and hospital affiliation.
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Yes, you can visit a MinuteClinic® for urgent care with a $0 copay.
Pharmacy
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The pharmacy you visit has access to the Aetna claim system and can determine what your cost sharing is for covered prescription drugs. In other words, they will tell you what you owe for any prescription you have filled. If you are enrolled in the Aetna Medicare Advantage plan, your prescription copays for a 30-day supply are:
$2 per covered generic formulary drug
$10 per covered generic drug not on the formulary
$40 per covered brand name formulary drug
$75 per covered brand name drug not on the formulary
25% for specialty drugs ($350 maximum)
If you are not enrolled in the Aetna Medicare Advantage plan, the formulary and the cost of your prescriptions is different. See the plan brochure for details.
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Yes, mail-order pharmacy is available for maintenance medications. Your share of the cost for a 90-day prescription will be the equivalent of two retail copays.
Go to your member website and select "Pharmacy" for details and forms.
What will I pay?
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Aetna Medicare Advantage is a Medicare Part C plan. Medicare pays Aetna® to administer the plan and cover your claims. Aetna Medicare Advantage provides all the benefits of Medicare Advantage but allows you to keep FEHB coverage. Once you are enrolled, you do not need to do anything, just use your Aetna Medicare Advantage ID card when you receive care. You’ll receive it in the mail.
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Once you have completed the two-step enrollment process, Medicare will have the necessary information to reduce the Part B premium for all eligible members on your plan. Your Social Security account will be credited $100 each month (up to $1,200 a year). Whether you pay your premium on a monthly, quarterly, semi-annual or annual basis, you’ll see a reduction of $100 per month.
While unlikely, it may take a few months to see the credit 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.
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If you have Medicare Parts A and B, your copay is $0 when you visit a provider that accepts Medicare and the Aetna plan.
Dental and vision
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The plan does not include dental coverage.
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Routine eye exams are covered in network at 100%.
Member perks
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Your member website is packed with health and benefits information. When you register, you can print temporary ID cards, check eligibility or claim status, and much more. Here are just a few of the highlights:
Cost estimator tools — Provides personalized cost information. You can estimate how much you’ll pay out of pocket for medical tests, office visits and procedures ahead of time. 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.
Personal Health Record (PHR) — A private and secure online tool that 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.
Our provider search tool — Helps you find doctors, hospitals and other providers that accept your plan. Using in-network providers will help you save money. The provider search tool also includes important provider credentials like education, board certification and languages spoken.
Aetna Health appSM — Puts the Aetna® online features at your fingertips. It allows you to view your member ID card, find a doctor, look up claims and access your PHR. The app is available on the App Store® Google Play. Just type Aetna.com into your mobile web browser.
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We’re committed to providing you with the resources, tools and support that help ensure you achieve your best health. All our health advocacy and wellness programs are included with your plan for no additional charge. Most of these programs are only available if you have selected the Medicare Advantage plan.
SilverSneakers®: An overall wellness program that may help you improve your health and live the life you want. The program gives you access to exercise equipment, classes and fun social activities at thousands of locations nationwide.
Teladoc®: Over 7,000 U.S. licensed doctors that you can meet with online, by phone or mobile app. (Available for all Aetna Medicare Advantage members.)
Hearing aid reimbursement:Hearing aid reimbursement to help you access the tools you need to engage and communicate with the world around you. Reimbursement is $2,500/every 36 months.
Resources For Living®: Aetna signature program helps you find the resources you need in your daily life. With just one call, a life consultant can help you find local resources to make life easier and treat your entire health, including your social and mental well-being.
Nonemergency transportation program: A program that ensures you make it to and from doctor or hospital appointments without always having to rely on family or friends.
Meal benefit program: Aetna offers a meal benefit through our relationship with NationsMarket for members recently discharged from the hospital. The program offers 14 home delivered meals; convenience for when making a meal is a difficult option.
Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.
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All members have access to Teladoc, a convenient, lower-cost alternative to urgent care or the emergency room. Teladoc lets you access board-certified doctors 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 1-855-Teladoc (1-855-835-2362 ) (TTY: 1-855-636-1578) to get started.
Teladoc doctors prescribe medical treatment for a wide range of conditions including cold and flu, pink eye, skin rash and stress/anxiety. They can even call in a prescription to your pharmacy of choice, when necessary.
All Teladoc doctors are U.S. board-certified providers and include internists, family doctors, dermatologists, psychiatrists and pediatricians that are licensed to practice medicine in the U.S.
Consultations are $49 copay or less for most services, depending on your plan, and do not require a referral. When you are enrolled in Aetna Medicare Advantage your Teladoc copay is $0.
Please note: Teladoc is not available to all members. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc.
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You must live or work in our service area to enroll in our plans.
If you opt in to the Aetna Medicare Advantage plan and are traveling overseas, emergency or urgently needed care is covered. Providers will work out payment with patients, and we will reimburse you for eligible covered medical expenses. For emergencies overseas we would reimburse and allow 100% of the submitted charges based on medical necessity.
If you are not in Aetna Medicare Advantage, 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.
DISCLAIMERS
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).
Aetna Resources For Living® is the brand name used for products and services offered through the Aetna group of subsidiary companies (Aetna).
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the plan’s applicable federal brochure(s). All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure.
The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. 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. Participating 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. SilverSneakers is a registered trademark of Tivity Health, Inc. © 2023 Tivity Health, Inc. All rights reserved. All trademarks and logos are the intellectual property of their respective owners. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7-10 days. You can call 1-888-792- 3862, (TTY users should call 711) 24 hours a day, seven days a week, if you do not receive your mail-order drugs within this timeframe. [Members may have the option to sign-up for automated mail-order delivery.]
External websites links are provided for your information and convenience only and do not imply or mean that Aetna endorses the content of such linked websites or third-party services. Aetna has no control over the content or materials contained therein. Aetna therefore makes no warranties or representations, express or implied, about such linked websites, the third parties they are owned and operated by, and the information and/or the suitability or quality of the products contained on them.
Estimated costs are not available in all markets or for all services. We provide an estimate for the amount you would owe for a particular service based on your plan at that very point in time. It is not a guarantee. Actual costs may differ from an estimate for various reasons including claims processing times for other services, providers joining or leaving our network or changes to your plan. Health maintenance organization (HMO) members can only get estimated costs for doctor and outpatient facility services.
DISCOUNT OFFERS ARE NOT INSURANCE. They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties--you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts.
Discount vendors and providers are not agents of Aetna and are solely responsible for the products and services they provide. Discount offers are not guaranteed and may be ended at any time. Aetna may get a fee when you buy these discounted products and services.
Vision care providers are contracted through EyeMed Vision Care. LASIK surgery discounts are offered by the U.S. Laser Network and Qualsight.
Natural products and services are offered through ChooseHealthy®, a program provided by ChooseHealthy, Inc. which is a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a registered trademark of ASH and is used with permission.
©2023 Aetna Inc.
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