Medicare

Retiree Health Access® offers you access to health coverage regardless of your current health status. You have a choice of medical and prescription drug plan options available to replace the coverage Medicare provides.

You are eligible to enroll in a Retiree Health Access plan if you are at least 55 years of age with 5 years of service and your former employer participates in the program. You must also meet the following:

You meet your former employer's age and years' of service requirements.
You are no longer a full-time or part-time employee.
You are entitled to Medicare Part A.
You are enrolled in and paying for Medicare Part B.
You are otherwise eligible to participate in your former employer's retirement benefits program.

You may also enroll your dependents. If you have eligible dependents that are not eligible to enroll in Medicare, they may be eligible to enroll in a coverage option for those who are not eligible for Medicare. Your Personalized Enrollment Worksheet lists your eligible dependents and coverage options.

You may also get Medicare Part D prescription drug coverage through a Medicare Advantage plan. Log in and register to check your plan options charts and find out what is available to you.

Plan Overviews

The Medicare Advantage HMO plan sometimes referred to as Medicare Part C, provides Medicare Part A and Part B coverage. You choose a primary care physician to provide routine and basic care, and referrals to network specialists. You share in the cost of your care by paying a flat fee (copayment) for covered services. The plan pays benefits only when you receive care or referrals from your PCP (Primary Care Physicians).
The Medicare Advantage Private Fee for Service plan sometimes referred to as Medicare Part C, provides Medicare Part A and Part B coverage. You may receive care from any licensed provider who accepts payment from Medicare – the plan then goes one step further to provide more coverage than Original Medicare. You pay a flat fee (copayment) or percentage for most covered services.

The Medicare Advantage HMO Plan

Under the Medicare Advantage HMO plan:

You choose a PCP from the online provider directory (DocFind®) for yourself and each covered family member.
Your PCP provides routine, basic care and referrals to network specialists when needed.
Benefits are paid only when your PCP provides or refers care. If you seek care on your own, you pay the entire cost.
You share in the cost of your care by paying a flat fee (copayment) for most covered services. For some services, you may pay a percentage (coinsurance) of the covered expenses.
The plan covers preventive care in full. Preventive care includes services such as routine exams and certain cancer screenings.

The Medicare Advantage Private Fee for Service Plan

Under the Medicare Advantage Private Fee for Service plan:

You may receive care from any licensed provider who is eligible to receive payment from Medicare and agrees to treat you, and accepts the plan’s payment terms and conditions.
How and what you pay for care depends on the plan option you choose.
- You may pay a flat fee (copayment) for most covered services.
- Or you may meet an annual deductible, then pay a percentage (coinsurance) of the covered expenses.
The plan covers preventive care in full. Preventive care includes services such as routine exams and certain cancer screenings.

Please note: A Medicare Advantage Private Fee for Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies. You are encouraged to ask your healthcare providers if they accept the plan’s payment terms and conditions prior to enrollment. Providers can find Aetna’s terms and conditions on the website at: http://www.aetna.com/members/medicare/data/terms_conditions.pdf

How Medicare Works

Once you reach age 65, Medicare becomes your primary health insurance. Medicare is the federal health benefits program for people age 65 or older, and some disabled people under age 65. Medicare includes:

Medicare Part A, which covers hospital expenses.
Medicare Part B, which covers physician services.
Medicare Part D, which covers prescription drugs.

In order to be eligible to enroll in a Retiree Health Access Medicare plan, you must be currently enrolled in Medicare Parts A and B. You must also continue paying for Medicare Part B.

Medicare At a Glance

Medicare Service	Enrollment	Cost
Part A – Hospital Services	Once you turn 65, you are automatically enrolled in Medicare Part A.	Most people don’t need to pay a premium for Medicare Part A because they have contributed the required amount of payroll taxes during their working years. Medicare Part A covers hospital expenses and pays benefits (a percentage of covered expenses) once you have met an annual deductible.
Part B – Physician Services	You must actively enroll for Medicare Part B once you become eligible.	You pay a monthly premium for Medicare Part B, which is usually deducted from your Social Security check. Medicare Part B covers physician expenses and pays benefits (a percentage of covered expenses) once you have met an annual deductible.
Part D – Prescription Drugs	You must actively enroll for Medicare Part D once you become eligible.	The premium for Part D depends on where you live and which plan you choose. Go to plan options to learn more about the Medicare Part D plans available to you and their cost.

How Medicare Works with Your Retiree Health Access Plan

The Medicare Advantage HMO plan or the Medicare Advantage Private Fee for Service plan provide Medicare Part A and Part B coverage.
The Retiree Health Access prescription drug plans provide Medicare Part D coverage.

For more about your Retiree Health Access plan options:

For more about Medicare

Visit the Medicare website at www.medicare.gov or call 1-800-MEDICARE.

Prescription Drug Benefits

The Retiree Health Access® offers Medicare Part D prescription drug plans to help you with the cost of retail and mail service prescriptions. The plans provide prescription benefits in accordance with coverage options and rules established under the Medicare Modernization Act.

As you review your prescription drug plan options, keep in mind that each option follows the basic structure of Medicare Part D coverage. In addition, when you enroll in an Retiree Health Access prescription drug plan, you can take advantage of certain benefits and services.

How Medicare Part D Works

Medicare Part D has four stages of cost-sharing – deductible, initial coverage, the coverage gap (or “donut hole”) and catastrophic coverage.

The amount you pay for prescriptions at each stage depends on the plan option you choose and the type of drug used to fill your prescription.

Plan option: Log in and register to check your plan options and see how costs are shared under each option.
Type of drug:
- You pay the least for generic drugs.
- You pay more for brand-name preferred drugs listed on the plan’s formulary.
- You pay the most for brand-name non-preferred drugs – those not listed on the plan’s formulary.

The formulary is a list of preferred, FDA-approved drugs. You can look up your drugs on the list and see whether or not generic equivalents are available.

Aetna Prescription Drug Plan Services

When you enroll in a Retiree Health Access prescription drug plan, you get Medicare Part D coverage, plus all the benefits and services that come with being an Aetna member.

You can visit any of more than 57,000 retail pharmacies in Aetna's network to have prescriptions filled.

To find a participating retail pharmacy near you, use the online provider directory (DocFind®).

To fill long-term (up to a 90-day supply) prescriptions, you can use the Aetna Rx Home Delivery service.

You can use Aetna’s Specialty Pharmacy for hard-to-fill prescriptions such as injectables and medications that require refrigeration or special handling.

You can look up your drugs on Aetna’s formulary. The formulary is a list of preferred medications that are FDA approved.

Special Programs and Services

As an Aetna member, you can take advantage of:

Disease Management Program

If you’ve been diagnosed with one or more chronic conditions, the disease management program offers help from specially trained medical professionals in evaluating, understanding and managing your condition(s), along with your healthcare provider.

Health Risk Assessment Tools

Quick and easy health risk assessments determine your potential health care needs and offer helpful tips to manage health conditions.

Health and Wellness Discounts

Through your Retiree Health Access plan, you can take advantage of discounts on:

Vision care. You can save on eyeglass lenses and frames, contact lenses and LASIK surgery at thousands of eye care centers nationwide that belong to Aetna’s network.
Alternative health care. Your plan provides discounts on services such as massage, acupuncture and chiropractic services, as well as vitamins and nutritional supplements.
Fitness memberships and equipment. Discounts apply to certain fitness club memberships and home fitness equipment available through a national vendor.

Secure Member Website

Once you’re enrolled in an Aetna plan you’ll be able to use Aetna Navigator, a secure member website that offers self-service convenience, up-to-date health information, consumer tools and much more. You’ll need to register first -then you can log on to:

Find in-network doctors, dentists, hospitals, pharmacies and other providers near you.
Get information about your plan’s coverages, benefits, programs and special features.
Review claims information, including payments made.
Use cost-of-care tools to check the estimated average costs of medical services and prescription drugs in your area.
Compare local hospitals on the criteria most important to you.
Take care of personal benefits business such as requesting a replacement ID card and printing claim forms.
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