Aetna Direct Plan
Click on a question. Get an answer.-
Any active or retired federal employee can enroll in the Aetna Direct plan. However, this plan has several advantages for members who have primary coverage through Medicare Part A and B. For example, if you have Medicare primary, we waive the deductible and most medical coinsurance, as well as provide reimbursement for medical expenses such as prescription drug coverage or a portion of Medicare Part B premiums.
-
Aetna Direct plan is a whole new level of value with:
- Low monthly plan premiums – below the federal average
- A Medical Fund to help you pay Medicare Part B premiums ($900 Self Only and $1,800 Self Plus One and or Family) or to use for other out-of-pocket covered medical expenses like prescriptions
- Waived deductibles and coinsurance for medical services if Medicare Part A and Part B are primary and your provider accepts Medicare assignment (not required to stay in-network)
-
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 Direct planMonthly Rates Enrollment Code Non-Postal Postal Self Only N61 $153.16 $153.16 Self Plus One N63 $335.89 $335.89 Family N62 $386.25 $386.25 -
With this Plan, in-network preventive care is covered in full. If you're enrolled in Medicare Part A and B and Medicare is primary, we'll waive the deductible and your coinsurance for most medical services. The annual deductible will also be waived for pharmacy benefits, but cost sharing will still apply (even if Medicare parts A and B are primary).
If Medicare Part A and B are not primary, then after you have depleted the Medical Fund and paid the plan's deductible, the Plan typically pays 80% for in-network care, and 60% for out-of-network care. The deductibles are as follows:
- In-network: $1,600 for Self Only enrollment and $3,200 for Self Plus One or Family enrollment
- Out-of-network: $1,600 for Self Only enrollment and $3,200 for Self Plus One or Family enrollment, we pay benefits under traditional medical coverage.
-
The Aetna Direct plan is an excellent plan option for federal retirees who have Medicare Part A and B as their primary coverage. The premiums and out-of-pocket costs are significantly lower than most other federal plans. With the Aetna Direct plan, you can reimburse your Part B premiums from the Medical Fund in the amounts of $900 Self Only or $1,800 for Self Plus One or Family if funds are available. We also waive the deductible and coinsurance for most medical services if Medicare is primary. You will only pay a $6 copay for generic drugs at a retail pharmacy. Active employees are also eligible to enroll but will be responsible for the deductible and coinsurance.
-
This plan coordinates seamlessly with Medicare so there will be no paperwork for you to fill out or submit. If you are enrolled in the Aetna Direct plan and take Medicare Parts A and B and Medicare is primary, we will waive your deductible and coinsurance for most medical services. You can also use your Medical Fund ($900 Self Only or $1,800 Self Plus One or Family) to reimburse some of your Medicare Part B premiums by submitting proof of payment. When Medicare Part A and Part B are primary, you can see any provider in or out-of-network. You should ensure that the provider accepts Medicare's assignment. Be sure to tell us if you have Medicare Parts A and B or any other medical coverage.
-
The Fund ($900 Self Only or $1,800 Self Plus One or Family) is designed to reimburse Medicare Part B premiums, however it will also be used for other covered services including prescription drugs. To receive reimbursement for your Part B premium, simply submit proof of payment to Aetna. Be aware, the Fund automatically goes to out-of-pocket costs if you have not yet submitted forms to reimburse Part B premiums.
If you're not enrolled in Medicare Part B, the Fund can be used for other covered services including prescription drugs.
-
Remaining Medical Fund dollars roll over from year to year if you remain in the plan, up to the maximum rollover amount.
-
To submit your Medicare Part B premium payment for reimbursement from your Medical Fund, just go to www.socialsecurity.gov/myaccount and set up an account. From there, you can print a letter that verifies your benefits. And that's what you send us.
Simply mail that letter to Aetna at PO Box 14079, Lexington, KY 40512.
-
The pharmacy has access to Aetna's claim system and can determine at the point of sale what your cost sharing is for your covered prescription drug. In a retail setting, your share of the cost will be*:
- $6 per covered generic formulary drug
- 30% per covered brand name formulary drug up to a $600 maximum
- 50% per covered non-formulary (generic or brand name) drug up to a $600 maximum
- Specialty drugs are covered at 50% up to a $600 preferred or $1,200 non-preferred maximum
If you are enrolled in Medicare Part A and B and Medicare is primary, we will waive the deductible for pharmacy benefits. If Medicare is not primary, you must satisfy the deductible first.
*Note that using our Mail-Order Pharmacy can help save money on prescription costs.
-
Yes, Mail-Order Pharmacy is available for maintenance medications. If you choose to use Mail-Order pharmacy, your share of the cost for up to a 90-day prescription will be
- $2 per covered generic formulary drug
- 30% per covered brand name formulary drug up to a $100 maximum
- 50% per covered non-formulary (generic or brand name) drug up to a $200 maximum
Go to our secure member website and click on "pharmacy benefits" for details and forms.
-
Our 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 personalized cost information. You can estimate how much you’ll pay out of pocket for medical tests, office visits and procedures ahead of time. If Medicare 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 - A private and secure online tool that 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 – helps you find doctors, dentists, hospitals and other providers that accept your plan. Using in-network providers will help you save money. The provider search tool also includes important provider credentials like education, board certification and languages spoken.
- Aetna Mobile App™ - 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.
-
You can view your Medical Fund balance, check claims transactions and more on our secure member website. Or, you can call Member Services at 855-277-4356.
-
If you are a retiree and would like to enroll in the Aetna Direct plan:
- Call the Office of Personnel Management (OPM) Retirement Information Center at 888-767-6738 (or 1-855-887-4957 for a TDD for the hearing impaired).
- Send an email to OPM at retire@opm.gov.
- Detailed instructions and information on the Federal Employees Health Benefits Program enrollment process is available at Enroll Now. Enrollment procedures for active employees vary by agency.
-
If you do not receive your ID card by your effective date, you may use a copy of your SF2809 Form or electronic enrollment (e.g., Employee Express, PostalEase, etc.) confirmation. If you are enrolled in our system, you may register on our secure member website and print an ID card. After you register, simply click on "Get an ID card" and follow the instructions. You may use this printable version of your personal ID card if you need medical or dental care.
-
- Coverage and 2020 benefit changes for current members and annuitants begins on January 1, 2020. Coverage for new Aetna members (joining during Open Season) becomes effective on the first day of the first pay period in January 2020.
- If you enroll as a newly hired Federal Employee, you have 60 days to enroll in a Federal Employees Health Benefits (FEHB) plan. Your enrollment will become effective the beginning of the pay period after your enrollment s received.
-
You have several options:
- Review the Federal Plan brochure and other information on this website
- Visit our member website to see the resources and information available to you when you enroll. Enter the following username and password: Username: federal3| Password: federal3
- Call Aetna at 855-277-4356
- Chat live with a health plan specialist or schedule an appointment for a one-on one phone consultation at AetnaFedsLive.com
-
All 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 855-Teladoc to get started.
Teladoc doctors prescribe medical treatment for a wide range of conditions including cold & flu, Pink Eye, skin rash and stress/anxiety. 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.
Please note: 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
-
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, covered medical services received overseas would be considered out-of-network. See Section 7 of our federal brochure for more information on how to submit overseas claims.
-
Yes. You get access to great discounts on prescription eyewear, vision services, gyms, weight loss programs, chiropractic, acupuncture, massage, vitamins, electric toothbrushes, gum, mints, and more! Visit aetnafeds.com/perks.php for more information.
Trademarks included in this material are the intellectual property of their respective owners.
