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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.

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:

  • Lower 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 B are primary and your provider accepts Medicare assignment

2023 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 $160.35
Self +1: N63 $351.67
Self & Family: N62 $404.39

Your 2023 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*
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*
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*
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 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 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 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).

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. 

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

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.

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.

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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