Reach your health potential
At Aetna®, we believe in the need to take care of the whole you -- body, mind and spirit. With an Aetna retiree plan, you can enjoy a total approach to health and wellness, so you can age actively.
Video Transcript
Choosing the right plan
{Voice over}Picture this...
You’re out to dinner with a friend, and you order the same exact meal. But when your bills arrive, yours is $30 more than your friend’s bill.
That’s what can happen if you’re not careful about your health benefit plan choice. You can end up paying more for the same coverage.
So, it’s time to do some research into your Postal Service Employees Health Benefits (PSHB) Program options.
Let’s start with the basics. In most cases, turning 65 is when you become eligible for Medicare. Medicare Parts A and B are also called Original Medicare.
When you retire, and if you keep your PSHB plan, Medicare will become your primary health plan. That means Medicare pays most of your medical expenses.
What about the rest of your expenses? That’s where your secondary plan comes in — your PSHB plan. Many federal retirees simply keep the PSHB plan they had while they were working. Now that might seem like the best option, and it’s the easy one, but let’s take a closer look...
When you’re retired and enrolled in Original Medicare, your PSHB plan becomes secondary. That means Medicare will pay your health care expenses first, and your PSHB plan may cover extra costs not covered by Medicare.
[on screen text] Original Medicare has a deductible and only covers about 80% of your Part B services.
But you’re still responsible for paying your full PSHB premium, even though Medicare is your primary coverage
Luckily, there are other options. Since 2015, Aetna has offered a nationwide plan with low premiums that’s tailored to Federal retirees with Medicare Parts A and B.
And in 2020 we began offering a Medicare Advantage Plan
With an Aetna plan, there’s a good chance you can keep your doctors, lower your out-of-pocket costs, and you’ll even receive some reimbursement to help pay your Medicare Part B premiums.
Our Aetna Medicare Advantage plan even include extras like SilverSneakers® fitness classes and home-delivered meals after a hospital stay.
Be sure to check out our other videos, which explain the differences between the Aetna Direct Plan and Aetna Medicare Advantage Plan – and see what works for you! Or connect directly with one of our specialists to explore your options.
Your guide to 65 and beyond
Whether you’re turning 65, getting ready to retire, or would like to take advantage of your opportunity to change your health plan, we’re here to help. You might have questions, or not know where to start. That’s why we’re providing you with this information — to help you make educated decisions.
Our mission is to fit into your life – the way you want, when you want. We look forward to hearing from you.
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Retirement Planning Checklist
We’ve put together a retirement checklist to help guide you on your path to retirement health coverage. Whatever stage of your career you’re in, we have the resources to provide you with informed and personalized guidance.
Get more details about how Aetna’s plans for Postal Service retirees provide connected care that makes healthier, easier.
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Aetna Medicare Advantage » Aetna Direct »Top Retiree FAQs
Your most common questions — answered.
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Aetna® offers two plans through the Postal Service Health Benefits (PSHB) 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.
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.
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For Aetna Medicare Advantage there are two steps you must take.
For Aetna Direct, there is one.
Step-one for both plans:
You can enroll electronically using the Postal Service Health Benefits System health-benefits.opm.gov/pshb, or by calling the PSHB Helpline at 1-844-451-1261, Monday through Friday, 7 AM to 8:45 PM.
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
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Aetna Direct 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.
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Aetna Medicare Advantage monthly premium:
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the PSHB Program website or contact the agency which maintains your health benefits enrollment.
Monthly premium table of rates. Self only (HLD) $139.76 Self plus one (HLF) $307.46 Self and family (HLE) $370.35
Aetna Direct monthly premium:
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the PSHB Program website or contact the agency which maintains your health benefits enrollment.
Monthly premium table of rates. Self only (G3A) $164.50 Self plus one (G3C) $360.78 Self and family (G38) $414.87 -
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 (30 day supply)
Table of rates. Covered generic formulary $2 Covered generic non-formulary $10 Covered brand name formulary $40 Covered brand name non-formulary $75
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 -
Yes, mail-order pharmacy is available for maintenance medications (for example, 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 Pharmacy for the same cost as mail order.
Go to your Aetna member website for details and forms.
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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.
The Aetna Medicare Advantage plan lets you see any provider (in the network or not), and you pay the same out-of-pocket cost for both covered medical benefits, as long as the provider is:
- Eligible to receive payment under Medicare
- Willing to bill and accept payment from Aetna
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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.
Note: The Aetna Medicare Advantage plan lets you see any provider (in the network or not), and you pay the same out-of-pocket cost for both covered medical benefits, as long as the provider is:
- Eligible to receive payment under Medicare
- Willing to bill and accept payment from Aetna
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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).
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Yes, Aetna Medicare Advantage includes Healthy Home Visit program, SilverSneakers®, Post-discharge meal benefit program and nonemergency transportation program.
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As part of the Postal Service Health Benefits (PSHB) Program, retirees with Medicare A and/or B will have a Medicare Part D prescription drug plans to help you save money. If you’re a member 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.
Aetna Medicare is an PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 10-14 days. You can call the number on the back of your ID card if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary Participating 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. Plan features and availability may vary by service area. Out-of-network/non-contracted providers are under no obligation to treat plan 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. To send a complaint to Aetna, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week). If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance. SilverSneakers is a registered trademark of Tivity Health, Inc. © 2023 Tivity Health, Inc. All rights reserved.
We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex and do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. If you speak a language other than English, free language assistance services are available. Visit our website, call the phone number listed in this material or the phone number on your benefit ID card.
In addition, our health plan provides auxiliary aids and services, free of charge, when necessary, to ensure that people with disabilities have an equal opportunity to communicate effectively with us. Our health plan also provides language assistance services, free of charge, for people with limited English proficiency. If you need these services, visit our website, call the phone number listed in this material or on your benefit ID card.
If you believe that we have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Grievance Department (write to the address listed in your Evidence of Coverage). You can also file a grievance by phone by calling the Customer Service phone number listed on your benefit ID card (TTY: 711). If you need help filing a grievance, call Customer Service Department at the phone number on your benefit ID card.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at https://ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf.
ESPAÑOL (SPANISH): Si habla un idioma que no sea inglés, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Visite nuestro sitio web o llame al número de teléfono que figura en este documento.
繁體中文 (CHINESE): 如果您使用英文以外的語言，我們將提供免費的語言協助服務。請瀏覽我們的網站或撥打本文件中所列的電話號碼。
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).
Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to AetnaFeds.com
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