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.
| 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* |
|---|---|
| Fund |
|
| 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 |
|
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.| Benefit | What you'll pay |
|---|---|
| 30-day Supply through Retail |
|
| 90-day Supply through Retail or Mail |
|
| 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 Medicare Rx offered by SilverScript 2024 drug formulary (PDF)
Aetna Medicare Rx 2024 Prescription Drug Supplemental Benefit (PDF)
Aetna Direct with Aetna Medicare Rx Summary of Benefits (PDF)
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:
-
This is an exciting change offered for the first time in 2024 through the FEHB Program. 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 or Open Access (plan code JN) 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.
-
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.
-
No. Your FEHB premiums will not increase.
However, some members may be required to pay an extra charge, known as the Part D Income-Related Monthly Adjustment Amount (IRMAA). The extra charge is figured out using your modified adjusted gross income as reported on your IRS tax return from 2 years ago. If this amount is above a certain amount, you’ll pay your FEHB premium and the additional IRMAA. For more information on IRMAA, visit the Medicare website.
-
You can opt out of Aetna Medicare Rx offered by SilverScript between October 23, 2023 and December 31, 2023, by calling Members Services at 1-833-271-9775 (TTY: 711), Monday through Friday, 8 AM to 8 PM ET or go online at AetnaRetireeHealth.com/FEHBP.
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 AetnaRetireeHealth.com/FEHBP
Aetna Direct prescription drug benefits when Medicare is not primary
| Benefit | What you'll pay |
|---|---|
| Rx Retail Pharmacy (30-day supply of a covered drug) |
|
| Mail Order Drug or CVS Pharmacy® (up to 90-day supply of a covered drug) |
|
Paper brochures can be ordered by mail using this form.
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
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.
Video: Medicare Part D Prescription Drug Plans
