Aetna Open Access® Plan
National network of doctors, predictable costs, no referrals
2026 Biweekly rates for zip code
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 Open Access® HMO Plan | Code | Biweekly Premium |
|---|
Your 2026 benefits - DC, MD, Northern VA
| Plan Details | Basic Option (YOU PAY) |
|---|---|
| Preventive care copay | $0 |
| Primary care visit copay | $25 |
| Specialist visit copay | $55 |
| CVS Virtual Care | $0 |
| Prenatal Care | $0 |
| Inpatient hospital care | 20% of the plan allowance |
| Outpatient facility copay | $350 |
| Emergency room copay | $200 |
| Urgent care center copay | $50 |
| Lab/X-ray/diagnostic services | $25 PCP / $55 specialist ($100 for certain tests) |
| Prescription drug copays
(for a 30-day supply at a retail pharmacy) See Aetnafeds.com/Pharmacy for a list of participating pharmacies. |
|
| Preferred Generic formulary* | $10 |
| Preferred Brand-name formulary* | 50% up to $200 maximum |
| Non-preferred (generic or brand name)* | 50% up to $300 maximum |
Your plan requires the use of generic medication when a generic equivalent exists.**Get a 90-day supply for $20 for preferred generic drugs, 50% up to $400 max for preferred brand name drugs, 50% up to $600 max for non-preferred (generic or brand name) drugs through our mail order drug program or at a participating retail pharmacy. |
|
| Aetna Medicare Rx offered by SilverScript® for eligible Medicare members | |
Members with Medicare Part A and/or Part B primary will be automatically enrolled into the Open Access plan with Aetna Medicare Rx offered by SilverScript. With this Part D prescription drug plan option, it could mean significant savings in prescriptions costs. Your drugs will still be covered, but copays and coinsurance are lower. See benefits section below for more information. |
|
| Built-in Vision | |
| Routine eye exam copay | $55 |
| Money toward prescription eyewear | You get $100 every 24 months |
| Discounts on eyeglasses, contacts, eye exams and more | Included |
Built-in dental, too
Use our Advantage Dental Network. Call 800-537-9384 (TTY:711) to select a dentist OR to switch to our larger PPO network at no additional cost. It's your choice!
Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD).
PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists.***
Open Access Basic Option with Aetna Medicare Rx offered by SilverScript benefits
| Retail pharmacy (30-day supply of a covered drug) with Aetna Medicare Rx offered by SilverScript |
Preferred Generic: $0 Generic: Preferred $4; Standard $5 Preferred Brand: $40 Non-Preferred Brand: $100 Specialty: 25%; max $150 |
|---|---|
| Mail order pharmacy or CVS Pharmacy® (90-day supply of a covered drug) with Aetna Medicare Rx offered by SilverScript. See Aetnafeds.com/pharmacy for a listing of all participating pharmacies. | Preferred Generic: $0 Generic: Preferred $8; Standard $10 Preferred Brand: $80 Non-Preferred Brand: $200 Specialty: Limited to one month supply |
| 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. |
You might save by using mail order. You'll pay only two copay amounts for a 90-day supply.
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
For more information and benefits for Open Access High Option members, see: Aetna Medicare RX® offered by SilverScript® plan details page
Why choose the Aetna Open Access plan?
- Large nationwide Aetna Network
- 24 hours a day / 7 days a week access to doctors via video with CVS Virtual Care
- Built-in dental and vision coverage
- Predictable costs
- No referrals to network specialists
- Discounts on eyewear, LASIK laser eye surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*A formulary is a list of generic and brand-name drugs your health plan prefers.
** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
*** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount.
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. 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.
Aetna's Drug Guide is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change.
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.
Video: Medicare Part D Prescription Drug Plans