Federal Retiree Center

Aetna^® offers two plans through the Federal Employees Health Benefits (FEHB) Program. Both plans are designed for federal retirees who also have Original Medicare (Parts A and B). One is the Aetna Medicare Advantage plan and the other is Aetna Direct^SM.

By opting in to the Aetna Medicare Advantage plan, you’ll have $0 copays and coinsurance. In-network preventive care is covered at 100 percent.

With the Aetna Direct plan, you’ll also be covered 100 percent for in-network preventive care. In addition, when Original Medicare is your primary coverage, your deductibles and coinsurance are waived for most medical services.

And with both of these plans, it’s likely you’ll be able to continue to use your doctors. You can visit any provider that is licensed to receive Medicare payment even if they are not in the Aetna network.

For Aetna Medicare Advantage there are two steps you must take.
For Aetna Direct, there is one.

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Step-one for both plans:
You’ll enroll through the OPM Retirement website RetireeFEHB.opm.gov, or by calling the Office of Personnel Management (OPM) Retirement Information Center at 1-888-767-6738 (TTY: 1-800-878-5707), Monday through Friday, 9 AM to 6 PM in all time zones.

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Step-two for Aetna Medicare Advantage:
Once you’re 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 Medicare Advantage:

• Your Original Medicare (Parts A and B) effective dates
• Your Medicare Beneficiary ID

You may go to AetnaRetireeHealth.com/FEHBP or call us at 1-866-241-0262 (TTY: 711) Monday through Friday, 8 AM to 6 PM in all time zones and provide us with this information. If you’re over age 65, you’ll receive a reminder postcard.

Aetna Direct^SM coordinates seamlessly with Medicare so there will be no paperwork for you to fill out or submit. You can see any provider in or out of network, however you should make sure that they are eligible to receive Medicare payment. When you have Original Medicare as your primary coverage, your deductible and coinsurance for most medical services will be waived.

In order to opt in to the Aetna Medicare Advantage plan, you’ll need to have Original Medicare because a Medicare Advantage plan is Medicare Part C. Medicare pays Aetna^® to administer the plan and cover your claims. You’ll receive a new plan ID card in the mail, so be sure to use it when you get care. It will take the place of your Original Medicare ID card.

Aetna Medicare Advantage monthly premium:

Monthly premium table of rates.

Self only	$125.00
Self plus one	$275.00
Self and family	$331.25

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Aetna Direct monthly premium:

Monthly premium table of rates.

Self only	$160.80
Self plus one	$352.64
Self and family	$405.51

Most pharmacies have access to the Aetna 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:

Aetna Medicare Advantage

Table of rates.

Covered generic formulary	$2
Covered generic non-formulary	$10
Covered brand name formulary	$40
Covered brand name non-formulary	$75

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Aetna Direct with Aetna Medicare Rx^® offered through SilverScript^® Preferred and Standard pharmacies

Table of rates.

Tier 1 - Preferred generic	$0 copay
Tier 2 - Generic	Preferred $1 copay/Standard $2 copay
Tier 3 - Preferred brand	$45 copay
Tier 4 - Non-preferred brand	$75 copay
Tier 5 - Specialty (includes high-cost/unique generic and brand drugs)	25% coinsurance, but not more than $250

^*Note: By using our mail-order pharmacy, you can save money on prescription costs.

Yes, mail-order pharmacy is available for maintenance medications (drugs that treat chronic conditions such as diabetes, or heart disease). For Aetna Medicare Advantage, your share of the cost for up to a 90-day prescription will be the equivalent of two retail copays.

Also, you can get your 90-day prescription at a CVS retail pharmacy for the same cost as mail order.

Go to your secure member website for details and forms.

Even though you may be switching plans, you may still be able to use your same doctors. Just be sure they are eligible to receive Medicare payment. Your providers do not have to be in the Aetna network.

If you have Aetna Direct and Original Medicare, or if you have the Aetna Medicare Advantage plan, you’ll pay a $0 copay when the provider is eligible to receive Medicare payment.

You must live or work in our service area, which is nationwide, to enroll in our plan. Once enrolled in the plan, overseas emergency or urgently needed care is provided for covered medical services. Transportation would not be provided unless a medical transport is required. See Section 7 of the appropriate federal brochure for more information on how to submit overseas claims. Aetna Direct (PDF), Aetna Medicare Advantage (PDF).

Yes, Aetna Medicare Advantage includes Healthy Home Visits and programs like SilverSneakers^®, meal delivery after a hospital stay and nonemergency transportation to the doctor.

This is an exciting change offered for the first time in 2024 through the FEHB Program. The Office of Personnel Management (OPM) worked with health plans to introduce Medicare Part D prescription drug plans to help you save money. If you’re a member of our Aetna Direct or Aetna Open Access in the MD/DC/VA area and are enrolled in Medicare Part A and/or Part B, your plan will automatically enroll you in Aetna Medicare Rx^® offered through SilverScript^®, a Medicare Part D prescription drug plan (PDP). This could mean saving on your prescription costs. The same drugs are covered under the Aetna Medicare Rx plan offered through SilverScript, but copays and coinsurance can be lower. So, depending on your prescriptions, this could offer you a great opportunity to save while still enrolled in your current health plan.