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
2026 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 | $178.52 |
| Self +1: | N63 | $391.51 |
| Self & Family: | N62 | $450.21 |
Your 2026 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* |
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 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 Caremark.com
Aetna Direct prescription drug benefits when you opt out of the Aetna Medicare Rx offered by SilverScript.
| 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) |
|
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 plan's 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.
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. 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.
The Aetna Medicare Rx offered by SilverScript (EGWP) retiree pharmacy coverage is an enhanced Part D Employer Group Waiver Plan that is offered as a single integrated product. The enhanced Part D plan consists of two components: basic Medicare Part D benefits and supplemental benefits. Basic Medicare Part D benefits are offered by Aetna Medicare Rx offered by SilverScript (EGWP) based on our contract with CMS. We receive monthly payments from CMS to pay for basic Part D benefits. Supplemental benefits are non-Medicare benefits that provide enhanced coverage beyond basic Part D. Supplemental benefits are paid for by plan sponsors or members and may include benefits for non-Part D drugs. Aetna Medicare Rx offered by SilverScript (EGWP) reports claim information to CMS according to the source of applicable payment (Medicare Part D, plan sponsor or member).
Aetna Medicare Rx offered by SilverScript is a group standalone Medicare Prescription Drug Plan (PDP). This plan is offered by SilverScript Insurance Company, which has a Medicare contract. SilverScript Insurance Company and Aetna are affiliated companies. Enrollment in the plan depends on Medicare contract renewal.
Due to legislation in Arkansas, effective January 1, 2026, you may not be able to utilize the following services within the state of Arkansas, unless a court takes action: CVS Retail, CVS Caremark Mail Service, CVS Specialty, and OMNI Care long term pharmacies.
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