Aetna Advantage Health Plan
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At Aetna, we believe in the need to take care of the whole you — body, mind and spirit. That’s why we take a total approach to health and wellness, so you can age actively. The Aetna Advantage plan with the Aetna Medicare Advantage option offered through the Federal Employee Health Benefits (FEHB) plan is a nationwide plan that takes a total approach to your health. This plan offers value to federal retirees with Medicare Parts A & B by offering $0 deductibles, robust prescription drug coverage, and access to additional programs and services such as home health visits, meals, transportation and SilverSneakers®.
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Federal Retirees with Medicare Parts A & B will continue to pay Part B premium with the Aetna Advantage plan. It provides the same coverage as Original Medicare but with extra benefits you wouldn’t get, such as $0 deductibles and prescription benefits. You’ll also get access to programs that can help you reach your health potential, including SilverSneakers fitness membership, hearing aid reimbursement and more.
And you may be able to continue to use your doctors — or any provider that is licensed to receive Medicare payment and accept the Aetna plan.
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All eligible federal retirees with Medicare Parts A & B who are interested in a plan that works to provide great coverage by taking a total approach to your health. All eligible federal employees are also able to enroll. However, without Medicare Parts A & B, deductibles and coinsurance will apply. In addition, you must live or work in our service area to enroll.
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Aetna Advantage requires two easy steps for Retirees with Medicare Parts A & B:
Step 1: Enroll as you normally would through the OPM Retirement website retireefehb.opm.gov. Or you can call 1-888-767-6738 (TTY: 1-800-878-5707 days hours of ops). Enroll in Aetna Advantage using enrollment code Z24, Z26 or Z25.
Step 2: Provide Aetna with your Medicare information. Once you are enrolled through the OPM Retirement website, your basic information will be transferred to Aetna. (Please allow 7–10 business days.) In addition, we will need the following to complete your enrollment in Aetna Advantage:
- - Your original Medicare effective date for Parts A & B
- - Your Medicare Beneficiary ID
You may go to www.aetnaretireehealth.com/FEHBP or call us at 1-866-241-0262 and provide us with this information. If you are over age 65, a reminder postcard will be sent.
If you are not retired and/or do not have Medicare Parts A & B, detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available on our website at Enroll Now. Enrollment procedures vary by agency.
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Since Aetna Medicare Advantage is a Medicare Part C plan, we need your Medicare information to complete your enrollment per CMS regulations. Providing us with your Medicare information will allow us to enroll you in the Aetna Medicare Advantage plan.
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Selecting the Aetna Medicare Advantage plan does not change your FEHBP premium or enrollment code. Retirees with Medicare Parts A & B may elect to join the Aetna Medicare Advantage plan by following the two enrollment steps above. Doing so will provide you with extra benefits such as $0 deductibles and robust prescription benefits. You also have access to programs that may help you reach your health potential, including SilverSneakers® fitness membership, meal delivery services, transportation benefits, hearing aid reimbursement and more.
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Aetna Medicare Advantage is a Medicare Part C, or Medicare Advantage Plan. Medicare pays Aetna to administer the plan and cover your claims. Aetna Medicare Advantage provides all the benefits of Medicare Advantage and allows you to keep FEHB coverage. Once you are enrolled, you do not need to do anything, but be sure you use your Aetna Medicare Advantage ID card that you receive in the mail when you get care.
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No. This Aetna Medicare Advantage plan is a special offering that is available to you if you enroll in Aetna Advantage through FEHB and have Medicare Parts A & B. While it is a Medicare Part C plan, you do not need to suspend your FEHB.
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You will initially receive an ID card as a member of Aetna Advantage. After you provide your Medicare information, you will receive a second ID card which indicates you are in our Medicare Advantage PPO plan. You should always present this new card when asked for insurance information.
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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.
Premiums for the Aetna Advantage planMonthly Rates Enrollment Code Non-Postal Postal Self Only Z24 $115.96 $111.32 Self Plus One Z26 $255.11 $244.91 Family Z25 $307.29 $295.00 -
No, even though you may be switching plans, chances are you may be able to continue seeing your same doctors. With the Aetna Advantage including Medicare Advantage plan, the provider must be eligible to receive Medicare payment and accept your plan.
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Just like with any other Aetna plan, the pharmacy you visit has access to Aetna's claim system and can determine what your cost sharing is for your covered prescription drug. In other words, they will tell you what you will owe for any prescription you have filled. If you are enrolled in Aetna Advantage and are enrolled in the Aetna Medicare Advantage plan, your prescription copays will be:
- $2 per covered generic formulary drug
- $10 per covered generic drug not on the formulary
- $40 per covered brand name formulary drug
- $75 per covered brand name drug not on the formulary
- 25% for specialty drugs ($350 maximum)
If you are not enrolled in the Aetna Medicare Advantage plan, the formulary and the cost of your prescriptions is different. You can see the plan brochure for details.
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Yes, mail-order pharmacy is available for maintenance medications. Your share of the cost for up to a 90-day prescription will be the equivalent of two retail copays.
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We’re committed to providing you with the resources, tools and comprehensive support that help ensure you achieve your best health. All our health advocacy and wellness programs are available — at no extra cost to you. Most of these programs are only available if you have selected the Medicare Advantage plan.
SilverSneakers® An overall wellness program that may help you improve your health and live the life you want. The program gives you access to exercise equipment, classes and fun social activities at thousands of locations nationwide. Teladoc® Over 700 U.S. board-certified, state-licensed health care professionals that you can meet with online, by phone or mobile app. (Available for all Aetna Advantage members.) Hearing aid reimbursement Hearing aid reimbursement for retirees, to help you access the tools you need to engage and communicate with the world around you; reimbursement is $2,000/every 36 months. Resources For Living® Aetna signature program helps you find the resources you need in your daily life. With just one call, a life consultant can help you find local resources to make life easier and treat your entire health, including your social and mental well-being. Non-emergency transportation program A program that ensures you make it to and from doctor or hospital appointments without always having to rely on family or friends. Meal benefit program Aetna offers a meal benefit through our relationship with GA Foods for members recently discharged from the hospital. The program offers 14 home delivered meals; convenience for when making a meal is a difficult option. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.
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Your secure member website is packed with health and benefits information. When you register, you can print temporary ID cards, check eligibility or claim status, check Fund balances and much more. Here are just a few of the highlights:
- Cost estimator tools — provides insight into out-of-pocket costs for various medical services. If Medicare Advantage is your primary coverage, these estimates may not be representative of your actual costs.
- Hospital Comparison Tool — see how hospitals in your area rank by factors important to you.
- Personal Health Record — captures important health information in one place, helping you stay healthy with personalized alerts and reminders and allowing you to print and share your health history with your doctors.
- Our provider search tool — lists participating physicians, hospitals and other health care providers. The provider search tool also includes important provider credentials such as education, board certification and languages spoken.
- Aetna Mobile — puts Aetna's online features at your fingertips. It allows you to view your member ID card, find a doctor, look up claims and access your Personal Health Record (PHR). It's available for Android™ and iPhone® mobile devices*. Just type Aetna.com into your mobile web browser.
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Members have access to Teladoc, a convenient, lower-cost alternative to urgent care or the emergency room. Teladoc lets you access board-certified doctors by web, phone or mobile app in under 10 minutes. It's perfect for when you're traveling or when your doctor isn't available. Members simply visit Teladoc.com/Aetna or call 1-855-Teladoc to get started.
Teladoc doctors prescribe medical treatment for a wide range of conditions including cold & flu, pink eye, skin rash, stress/anxiety, and recommend treatment. They can even call in a prescription to your pharmacy of choice, when necessary. All Teladoc doctors:
- Are U.S. board certified internists, state-licensed family practitioners, and pediatricians licensed to practice medicine in the U.S.
- Are U.S. residents
Consultations are $40 or less for most services, depending on your plan, and do not require a referral.
Teladoc is not available to all members and operates subject to state regulations. Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna or plans administered by Aetna. For complete descriptions of the limitations of Teladoc services, visit Teladoc.com/Aetna.
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You must live or work in our service area to enroll in our plan. Return to the homepage to find plans available in your area. Once enrolled in the plan, emergency or urgently needed care is provided overseas. Transportation back to the United States would not be provided unless a medical transport is required.
You have several options:
- Visit aetnafeds.com/advantage
- Call Aetna at 1-855-277-4356
- Schedule an appointment for a one-on one phone consultation at AetnaFedsLive.com
- Chat live with a health plan specialist at AetnaFedsLive.com
- Review the Federal Plan brochure and other information on this website
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary 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.
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary. 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. 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.
