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Aetna Direct Plan℠

A whole new level of value for federal retirees

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

Although it’s not Medicare, 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:

  • Lower monthly plan premiums
  • 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 B are primary and your provider accepts Medicare assignment

2024 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 Code Monthly Premium
Self Only: N61 $160.80
Self +1: N63 $352.64
Self & Family: N62 $405.51

Your 2024 benefits (in-network)

Benefit With Medicare A and 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*
PCP You pay nothing*
Specialist You pay nothing*
Coinsurance You pay nothing*
Inpatient Hospital You pay nothing*
MinuteClinic® or Walk in clinic 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*
Out of Pocket Maximum
  • $6,000 self
  • $12,000 self plus one
  • $12,000 self and family

Prescription drug benefits when you’re enrolled in Medicare Part A (or Parts A and B): Aetna Medicare Rx offered by SilverScript

Members with Medicare Part A and/or Part B primary will be automatically enrolled into Aetna Medicare Rx® offered by SilverScript®. With this Part D prescription drug option, it could mean significant savings in prescriptions costs. Your drugs will still be covered, but copays and coinsurance are lower. See benefits below for plan details.
Table of rates.
Benefit What you'll pay
30-day Supply through Retail
  • Tier 1 Preferred generic: $0
  • Tier 2 Generic: $1 from a preferred pharmacy ($2 from a standard pharmacy)
  • Tier 3 Preferred brand: $45
  • Tier 4 Non-preferred brand: $75
  • Tier 5 Specialty: 25% up to $250
90-day Supply through Retail or Mail
  • Tier 1 Preferred Generic: $0
  • Tier 2 Generic: $2 from preferred mail order or pharmacy ($4 from standard mail order or pharmacy)
  • Tier 3 Preferred Brand: $75
  • Tier 4 Non-Preferred Brand: $125
  • Tier 5 Specialty Limited to a one-month supply
Out of Pocket Maximum for prescription drugs Once you reach the $2,000 max for prescription drugs, you will pay $0 for prescription drugs. This $2,000 will also apply to the medical plan’s total calendar year out-of-pocket maximum.

Aetna Direct with Aetna Medicare Rx Plan FAQs

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). Below are some frequently asked questions:

View all the PDP FAQs here

Resources and Contact Information

Call Members Services at 1-833-271-9775 (TTY: 711), Monday through Friday, 8 AM to 8 PM ET or go online at

Aetna Direct prescription drug benefits when Medicare is not primary

Table of rates.
Benefit What you'll pay
Rx Retail Pharmacy
(30-day supply of a covered drug)
  • Tier 1 Preferred Generic: $6
  • Tier 2 Preferred Brand: 30% up to $600
  • Tier 3 Non-preferred Generic or Brand: 50% up to $600
  • Tier 4 Preferred Specialty: 50% up to $600
  • Tier 5 Non-preferred Specialty: 50% up to $1,200
Mail Order Drug or CVS Pharmacy®
(up to 90-day supply of a covered drug)
  • Tier 1 Preferred Generic: $2 per covered generic drug
  • Tier 2 Preferred Brand: 30% up to $100
  • Tier 3 Non-preferred Generic or Brand: 50% up to $200

If Medicare Parts A and B are not your primary coverage (for example, you are an active employee or retired without Medicare Parts A and 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.

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. Aetna Medicare Rx offered by SilverScript is a standalone Prescription Drug Plan offered by SilverScript® Insurance Company, a CVS Health company.

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. Aetna's Drug Guide is subject to change. 

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. The 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 days. You can call 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.] 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.

For a complete list of other participating pharmacies log in to your member website to use our provider search tool. 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. For your best health, we encourage you to have a relationship with a primary care physician or other doctor. Tell them about your visit to MinuteClinic, or MinuteClinic can send a summary of your visit directly to them. 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 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. 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.

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