About the plan:
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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 or $1,800 Self plus one and Self and 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 is eligible to accept Medicare payment (not required in-network)
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With this plan, in-network preventive care is covered at 100%. 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 for pharmacy benefits (even if Medicare Parts A and B are primary).
Note: Members without Medicare have a deductible, coinsurance and different prescription benefits. -
The Aetna Direct plan is an excellent plan option for federal retirees who have Medicare Parts A and B as their primary coverage. The premiums and out-of-pocket costs are lower than most other federal plans. With the Aetna Direct plan, you can reimburse yourself for your Part B premiums from the medical fund in the amounts of $900 for Self only and $1,800 for Self plus one or Self and 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 $6 copay for generic drugs at a retail pharmacy. You have the flexibility to see any Medicare participating provider whether or not they are part of the Aetna® network. Active employees are also eligible to enroll but will be responsible for the deductible and coinsurance and will have different prescription drug cost sharing.
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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.
Monthly premiums for the Aetna Direct plan: Aetna Direct Enrollment code Monthly premium Self only N61 $166.53 Self plus one N63 $365.21 Self and family N62 $419.96 -
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 you are enrolled in 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 and Self and family) to reimburse yourself for some of your Medicare Part B premiums by submitting proof of payment (PDF). 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.
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To get your Medicare Part B premium reimbursement from your medical fund, just go to SSA.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 along with the Aetna Direct Plan Medicare Premium Reimbursement Form to Aetna at PO Box 14079, Lexington, KY 40512 or fax to 1-859-455-8650.
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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
- 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.
Doctors and Networks:
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No. You can use any provider who participates with Medicare or is eligible to receive Medicare payment. This means that even though you may be switching plans, chances are you may be able to continue seeing your same doctors.
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You can search for providers who participate with Medicare or accept Medicare payment. Please visit Medicare.gov/PhysicianCompare to search near you. You can filter provider results by distance, gender and hospital affiliation.
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If you have Medicare Parts A and B, you pay nothing when you visit a Medicare participating provider.
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Yes, if you have Medicare Parts A and B (primary) you can visit a MinuteClinic® for services with a $0 copay.* For members who do not have Medicare Parts A and B, $0 copay will apply once the deductible has been met.
* FOR $0 MINUTECLINIC: Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventive MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states and on indemnity plans.
Pharmacy:
When you are enrolled in Medicare Part A and/or Part B, your pharmacy benefit will be covered under Aetna Medicare Rx® offered through SilverScript®, a Medicare Part D prescription drug plan (PDP).
Medicare Part D Prescription Drug Plan (PDP) coverage included in Aetna Direct:
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The Office of Personnel Management (OPM) worked with health plans to introduce Medicare Part D prescription drug plans to help you save money. If you’re enrolled in Medicare Part A and/or Part B, your Aetna Direct plan will automatically enroll you in Aetna Medicare Rx® offered through SilverScript®, a Medicare Part D prescription drug plan (PDP). This could mean saving on your prescription costs. The same drugs are covered under the Aetna Medicare Rx plan offered through SilverScript, but copays and coinsurance can be lower. So, depending on your prescriptions, this could offer you a great opportunity to save while still enrolled in your current health plan.
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The Medicare Part D PDP is a Medicare approved prescription drug plan that is governed by CMS.
When you have Aetna Medicare Rx offered by SilverScript your prescription costs will generally be lower.
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No. Your FEHB premiums will not increase.
However, if your income is above a certain limit, the Social Security Administration (SSA) will require an Income Related Monthly Adjustment Amount (IRMAA) based on your yearly income. This extra charge is in addition to your monthly Medicare premiums for Part B and/or Part D. If IRMAA applies SSA will notify you with information on how to pay IRMAA and your right to appeal. Aetna is not responsible for IRMAA, please see the SSA website for more information.
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Yes.
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No. Your out-of-pocket costs for prescription drugs should decrease with Aetna Medicare Rx offered by SilverScript.
Please check the formulary to find out what tier your medications will be on.
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With the PDP, Your share of the cost for up to a 30-day prescription will be:
Preferred and Standard pharmacies Tier 1 - Preferred generic $0 copay Tier 2 - Generic Preferred $1 copay/Standard $2 copay Tier 3 - Preferred brand $45 copay Tier 4 - Non-preferred brand $75 copay Tier 5 - Specialty (includes high-cost/unique generic and brand drugs) 25% coinsurance, but not more than $250 -
Yes, mail-order pharmacy is available for maintenance medications.
Your share of the cost for up to a 90-day prescription will be:
Preferred and Standard retail and mail order Tier 1 - Preferred generic $0 copay Tier 2 - Generic Preferred $2 copay/Standard $4 copay Tier 3 - Preferred brand $75 copay Tier 4 - Non-preferred brand $125 copay Tier 5 - Specialty (includes high-cost/unique generic and brand drugs) Limited to a one month supply -
Yes. You will receive an additional card for your Medicare Part D PDP coverage. You will need to present your new card at the pharmacy.
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You can use our provider search tool to find standard and preferred pharmacies near you.
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Visit Caremark.com to register for your member portal with the information on your new prescription ID card.
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You can opt out of Aetna Medicare Rx offered by SilverScript at any time by calling Member Services at 1-833-271-9775 (TTY:711), Monday through Friday, 8 AM to 8 PM ET or go online at AetnaRetireeHealth.com/FEHBP.
Pharmacy:
When you don’t have Medicare Part A and/or Part B, or you choose to opt out of the Aetna Medicare Rx plan offered through SilverScript:
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The pharmacy has access to the Aetna claim system and can determine at the point of sale what your cost sharing is for your covered prescription drug.
In a retail setting, your share of the cost for a 30-day supply will be*:
$6 copay for a covered generic formulary drug
30% of the cost of a covered brand name formulary drug up to a $600 maximum amount
50% of the cost of a covered non-formulary (generic or brand name) drug up to a $600 maximum amount
Specialty covered drugs are 50% of the cost up to a $600 preferred or $1,200 non-preferred maximum.
If you are enrolled in Medicare Part A and B and Medicare is primary, we will waive the deductible for pharmacy benefits. If Medicare is not primary, you must satisfy the deductible first.
* FOR 90-DAY SUPPLY COST: Using our Mail-Order Pharmacy can help save money on prescription costs.
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Yes, mail-order pharmacy is available for maintenance medications.
Your share of the cost for up to a 90-day prescription will be:
$2 for a covered generic formulary drug
30% of the cost of a covered brand name formulary drug up to a $100 maximum amount
50% of the cost of a covered non-formulary (generic or brand name) drug up to a $200 maximum amount
You can also get your 90-day prescription at a CVS Pharmacy® for the same cost as mail-order.
Go to your member website and select "pharmacy benefits" for details and forms.
About the Fund:
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The medical fund ($900 Self only or $1,800 Self plus one and Self and family) is designed to reimburse you for your Medicare Part B premiums. To receive reimbursement for your Part B premiums, simply submit proof of payment to Aetna.
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You can view your medical fund balance, check claims transactions and more on your member website. Or, you can call Aetna at 1-855-277-4356 (TTY:711) Monday through Friday, 8 AM to 6 PM in all time zones.
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Remaining medical fund dollars roll over from year to year if you remain in the plan, up to the maximum rollover amount.
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Your annual medical fund amount is $900 for Self only coverage or $1,800 for Self plus one and Self and family coverage.
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No. The medical fund is a benefit and not considered taxable income.
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When you have Medicare Parts A and B as primary, and you visit a Medicare participating provider, we waive your deductible and coinsurance. That will not come out of your fund. Your medical fund can be used to reimburse yourself for your prescriptions copays until it is gone, or you may submit for reimbursement of your Medicare Part B premiums.
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No. All Self plus one and Self and family members covered under your plan share the medical fund.
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No. While the balance remaining in the medical fund at the end of the year will roll over if you remain enrolled in Aetna Direct (up to the rollover maximum), the medical fund is only available to pay expenses covered under the Plan.
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You lose any remaining medical fund balance if you leave the Aetna Direct plan.
Dental and Vision:
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Aetna Direct does not include dental coverage.
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Aetna Direct does not include vision coverage.
Enrollment:
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If you are a retiree and would like to enroll in the Aetna Direct plan:
During the annual FEHB Open Season, anyone eligible to participate in the FEHB Program may change health plans or options, cancel or suspend their FEHB enrollment, and request plan brochures and information. Annuitants can do the above actions by:
- Using OPM's Open Season Online system.
- Using Open Season Express by calling 1-800-332-9798 (TTY:711) Monday through Friday 8 AM to 6 PM in all time zones.
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Sending regular mail (Postmarked no later than final date of Open Season) to:
Office of Personnel Management
Open Season Processing Center
P.O. Box 5000
Lawrence, KS 66046-0500
When using this option, please clearly state your Open Season request. To choose the Aetna Direct Plan, state you would like enrollment code N61 for Self only, N63 for Self plus one, or N62 for Self and family. Remember to include your annuity claim number and Social Security number on your request. If you are choosing Self plus one or Self and family coverage, we will also need your eligible family member’s information and other insurance information as specified in the instructions mailed to you at the beginning of Open Season.
Outside of the annual FEHB Open Season, call the Office of Personnel Management (OPM) Retirement Information Center at 1-888-767-6738 (or TTY:711) Monday through Friday 8 AM to 6 PM in all time zones.
Send an email to OPM at retire@opm.gov
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.
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Coverage and 2025 benefit changes for current members and annuitants began on January 1, 2025. Coverage for Aetna members who are actively employed and joined during Open Season became effective on the first day of the first pay period in January 2025.
If you enroll as a newly hired Federal Employee, you have 60 days to enroll in a Federal Employees Health Benefits (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, select “Get an ID card” and follow the instructions. You may use this printable version of your personal ID card if you need medical or dental care.
Online tools and resources:
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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, check Fund balances 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 — 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, dentists, 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 HealthSM app — Puts our 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). The app is available on the App Store® and Google Play. Or type Aetna.com into your mobile web browser, scroll to the bottom of the page and select “Aetna Apps”. You can download it from there.
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Yes. Virtual care is a convenient, lower-cost alternative to urgent care or the emergency room. And it’s in addition to your traditional network of providers to give you more options. It's perfect for when you're traveling or when your doctor isn't available. With these virtual options, you can get care ASAP for nonemergency conditions such as cold & flu, sinus infections, Pink Eye, allergies and more. You can also take care of your mental well-being by talking with a therapist for anxiety or stress. They can even call in a prescription to your pharmacy of choice, when necessary.
Members have access to CVS Health Virtual Care™.
To access CVS Health Virtual Care register and make an appointment today at CVS Virtual Care
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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.
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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! Learn more AetnaFeds.com/perks
DISCLAIMERS
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna, CVS Pharmacy® and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.
This is a brief description of the features of the 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.
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.
Aetna Medicare Rx offered by SilverScript is a standalone Prescription Drug Plan offered by SilverScript® Insurance Company, a CVS Health company.
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. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary. 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: 711), 24 hours a day, seven days a week, if you do not receive your mail-order drugs within this timeframe. The Aetna Medicare pharmacy network includes limited lower cost, preferred pharmacies in: applicable areas. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at http://www.aetnamedicare.com/pharmacyhelp.
All trademarks and logos are the intellectual property of their respective owners.
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.
External websites links are provided for your information and convenience only and does 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.
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