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Aetna Direct

A whole new level of value for federal retirees

Aetna Direct℠ is unlike any other federal health plan you’ve seen.

It’s not Medicare, but it works seamlessly with Medicare. With Aetna Direct you can get unmatched money saving features – low plan premiums, low out-of-pocket costs, and a large national network of doctors.

Aetna Direct is a whole new level of value with:

  • Low monthly plan premiums – below the federal average
  • A fund to help you pay Medicare Part B premiums ($900/self and $1,800/self plus one or self and family)
  • Waived deductibles and copayments for medical services – if Medicare Part A and Part B are primary and your provider accepts Medicare assignment

2021 Rates

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.
Table of rates.
Aetna Direct - Monthly Code Non-Postal
Self Only: N61 $153.96
Self +1: N63 $337.64
Self & Family: N62 $388.27

Your 2021 benefits (in-network)

Table of rates.
Benefit With Medicare A & B primary*
  • $900 self
  • $1,800 self plus one
  • $1,800 self and family
Part B Premium Reimbursement You have the option to use your fund to reimburse yourself for your Medicare Part B premium.
Deductible Waived*
Out of Pocket Maximum
  • $6,000 self
  • $12,000 self plus one
  • $12,000 self and family
PCP You pay nothing*
Specialist You pay nothing*
Coinsurance You pay nothing*
Inpatient Hospital You pay nothing*
Outpatient Hospital You pay nothing*
Urgent Care You pay nothing*
Emergency Care You pay nothing*
Lab/X-ray/Diagnostic Services You pay nothing*
Rx Retail Pharmacy
  • $6 per covered generic formulary drug
  • 30% per covered brand name formulary drug, max of $600
  • 50% per covered non-formulary (generic or brand name) drug, max of $600
Mail Order Drug or CVS Retail Pharmacy (up to 90 day supply)
  • $2 per covered generic formulary drug
  • 30%, max of $100 per covered brand name formulary drug
  • 50%, max of $200 per covered non-formulary (generic or brand name) drug

If Medicare Part A & B are not your primary coverage (for example, you are an active employee or retired without Medicare A&B), you will be responsible for the deductible and coinsurance. Please see the plans OPM brochure (PDF) for coverage details.

*If you are covered by Medicare Part B and it is primary, your out-of-pocket costs for services that both Medicare Part B and we cover depend on whether your physician accepts Medicare assignment for the claim.

If your physician accepts Medicare assignment, then you pay nothing for covered charges.
If your physician does not accept Medicare assignment, then you pay the difference between the "limiting charge" or the physician's charge (whichever is less) and our payment combined with Medicare's payment.

Health insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (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. Plan features and availability may vary by location and are subject to change. Pharmacy clinical programs such as precertification, step therapy, and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Discount programs are neither offered nor guaranteed under our contract with the FEHB Program, but are made available to all enrollees and their families who become members under an Aetna Health Insurance Plan. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Information is believed to be accurate as of the production date; however, it is subject to change.

All Aetna plans include discounts on eyewear, LASIK eye surgery, gym memberships, massage therapy, acupuncture, weight-loss programs and more.

For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision Preferred site.

Postal and Non-Postal rates

  • Non-Postal rates apply to most non-Postal employees.
  • Postal rates apply to United States Postal Service employees.
  • Postal Category 1 rates apply to career bargaining unit employees represented by the APWU, IT/AS, NALC and NPMHU.
  • Postal Category 2 rates apply to career bargaining unit employees represented by the PPOA.
  • Non-Postal rates apply to all career non-bargaining unit Postal Service employees and career employees represented by the NRLCA agreement.
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