Aetna Direct Plan
Click on a question. Get an answer.About the Plan
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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 Self and 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)
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With this Plan, in-network preventive care is covered at 100%. 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 for pharmacy benefits (even if Medicare parts A and B are primary).
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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 yourself for your Part B premiums from the Medical Fund in the amounts of $900 Self Only or $1,800 for Self Plus One or Self and 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. You have the flexibility to see any Medicare participating provider whether or not they are part of the Aetna network. Active employees are also eligible to enroll but will be responsible for the deductible and coinsurance.
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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 Direct plan: Monthly Rates Enrollment Code Non-Postal Self Only N61 $157.07 Self Plus One N63 $344.47 Family N62 $396.12 -
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 you are enrolled in 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 Self and Family) to reimburse yourself for 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.
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To get your Medicare Part B premium reimbursement from your Medical Fund, just go to ssa.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 along with the Aetna Direct Plan Medicare Premium Reimbursement Form to Aetna at PO Box 14079, Lexington, KY 40512 or fax to 1-859-455-8650.
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You have several options:
- Chat live with a health plan specialist or schedule an appointment for a one-on one phone consultation at AetnaFedsLive.com
- Review the Federal Plan brochure and other information on this website
- Call Aetna at 1-855-277-4356 (TTY:711)
Doctors and Networks
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No. You can use any provider who participates with Medicare or accepts Medicare Assignment. This means that even though you may be switching plans, chances are you may be able to continue seeing your same doctors.
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You can search for providers who participate with Medicare or accept Medicare Assignment on Medicare's website. Please visit medicare.gov/physiciancompare/ to search near you. You can filter provider results by distance, gender, and hospital affiliation.
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If you have Medicare Parts A and B, you pay nothing when you visit a Medicare Participating provider.
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Yes, if you have Medicare parts A and B (primary) you can visit a MinuteClinic® for services with a $0 copay. For members who do not have Medicare parts A and B, $0 copay will apply once the deductible has been met.
Pharmacy
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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 for a 30-day supply 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.
- If you have a balance in your Medical Fund, all pharmacy charges will be paid by the Fund until it is exhausted.
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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:
- $2 per covered generic formulary drug
- 30% up to $100 maximum per covered brand name formulary drug
- 50% up to $200 maximum per covered non-formulary (generic or brand name) drug.
- You can also get your 90-day prescription at a CVS Pharmacy® for the same cost as mail-order.
Go to our member website and click on "pharmacy benefits" for details and forms.
About the Fund
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The Fund ($900 Self Only or $1,800 Self Plus One or Self and 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.
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You can view your medical fund balance, check claims transactions and more on our member website. Or, you can call Member Services at 1-855-277-4356 (TTY:711).
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Remaining medical fund dollars roll over from year to year if you remain in the plan, up to the maximum rollover amount.
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Your annual medical fund amount is $900 for Self Only coverage and $1,800 for Self Plus One and Self and Family Coverage.
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No. Payments from the medical fund are benefits and not considered taxable income.
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When you have Medicare Parts A and B primary and visit Medicare Participating providers, we waive your deductible and coinsurance, so that will not come out of your fund. Your medical fund will pay for your prescriptions until it is gone or you may submit for reimbursement of your Medicare Part B premiums.
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No. All Self Plus One and Self and Family members covered under your plan share the medical fund.
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No. While the balance remaining in the medical funds at the end of the year will roll over if you remain enrolled in Aetna Direct (up to the rollover maximum), the medical funds are only available to pay expenses covered under the Plan.
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You lose any remaining medical fund balances if you leave the Aetna Direct Plan.
Dental and Vision
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Aetna Direct does not include dental coverage.
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Aetna Direct does not include vision coverage.
Enrollment
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If you are a retiree and would like to enroll in the Aetna Direct plan:
During the annual FEHB Open Season, anyone eligible to participate in the FEHB Program may change health plans or options, cancel or suspend their FEHB enrollment, and request plan brochures and information. Annuitants can do the above actions by:
- Using OPM's Open Season Online system.
- Using Open Season Express by calling 1-800-332-9798.
- Sending regular mail (Postmarked no later than final date of Open Season) to:
Office of Personnel Management
Open Season Processing Center
P.O. Box 5000
Lawrence, KS 66046-0500When using this option, please clearly state your Open Season request. To choose the Aetna Direct Plan, state you would like enrollment code N61 for Self Only, N63 for Self Plus One, or N62 for Self and Family. Remember to include your annuity claim number and social security number on your request. If you are choosing Self Plus One or Self and Family coverage, we will also need your eligible Self and Family member’s information and other insurance information as specified in the instructions mailed to you at the beginning of Open Season.
Outside of the annual FEHB Open Season, call the Office of Personnel Management (OPM) Retirement Information Center at 1-888-767-6738 (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.
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Coverage and 2022 benefit changes for current members and annuitants begins on January 1, 2022. Coverage for Aetna members who are actively employed joining during Open Season becomes effective on the first day of the first pay period in January 2022.
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 is received.
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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 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.
Member Perks
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Our member website is packed with health and benefits information. When you register, you can print temporary ID cards, check eligibility or claim status, 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). The app is available on the App Store® and Google Play. Just type Aetna.com into your mobile web browser.
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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 1-855-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 $49 or less for most services, depending on your plan, and do not require a referral.
Please note: Teladoc® is not available to all members. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc.
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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, you are only covered for emergency care overseas. See Section 7 of our federal brochure for more information on how to submit overseas claims.
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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 for more information.
All trademarks and logos included in this material are the intellectual property of their respective owners.
Estimated costs are not available in all markets or for all services. We provide an estimate for the amount you would owe for a particular service based on your plan at that very point in time. It is not a guarantee. Actual costs may differ from an estimate for various reasons including claims processing times for other services, providers joining or leaving our network or changes to your plan. Health maintenance organization (HMO) members can only get estimated costs for doctor and outpatient facility services.
External websites links are provided for your information and convenience only and does not imply or mean that Aetna endorses the content of such linked websites or third-party services. Aetna has no control over the content or materials contained therein. Aetna therefore makes no warranties or representations, express or implied, about such linked websites, the third parties they are owned and operated by, and the information and/or the suitability or quality of the products contained on them.
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.
Discount vendors and providers are not agents of Aetna and are solely responsible for the products and services they provide. Discount offers are not guaranteed and may be ended at any time. Aetna may get a fee when you buy these discounted products and services.
Vision care providers are contracted through EyeMed Vision Care. LASIK surgery discounts are offered by the U.S. Laser Network and Qualsight. Natural products and services are offered through ChooseHealthy®, a program provided by ChooseHealthy, Inc. which is a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a registered trademark of ASH and is used with permission.
Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.
Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor.
Apple, the Apple logo, iPhone and Apple Watch are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple, Inc.
Google Play and the Google Play logo are trademarks of Google LLC.
