Foreign Service Benefit plan

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Retiree Plan Details

FSBP – Aetna Medicare Advantage plan for retirees with Medicare Parts A and B.

Get to know your Retiree plan and extras

As an Aetna Medicare Advantage for FSBP member, you’ll get benefits and programs that address the whole you — physical, emotional and social — at no additional cost to you.

How the plan works

You’ll have $0 deductibles, copayments and coinsurance for most medical care. With FSBP — Aetna Medicare Advantage, members will get additional benefits and added programs that aren’t included with the FSBP High Option for no additional FEHB premium.

Benefits wherever you are

This plan lets you use any doctors and hospitals that are licensed to receive Medicare payment and willing to accept and bill your plan.

And with the Aetna Medicare Advantage for FSBP, your coverage follows you wherever you travel, nationwide.

*It allows you to see any provider (whether in the network or not), and you pay the same out-of-pocket cost for both covered in-network and out-of-network medical benefits, as long as the provider is:

  • Eligible to receive payment under Medicare
  • Willing to bill and accept payment from Aetna®

Wellness and value-added programs

A licensed and board-certified nurse practitioner or doctor will come to your home to provide an assessment. After your visit, we share the information with your doctor.

Your Aetna Medicare Advantage plan includes an over-the-counter (OTC) supplies benefit. It offers a convenient way to get OTC health and wellness products delivered straight to your home.

Your OTC supplies benefit can be used on items like pain relief, cold and allergy remedies, first aid supplies, dental and eye care, vitamins and minerals and personal care items including sunscreen, lotions, cotton swabs and more.

Learn more about over the counter supplies.

Aetna Medicare Advantage members receive a $30 allowance to spend each calendar quarter.

Physical activity can improve your health and well-being. As a Medicare Advantage member, you get access to:

  • Membership at thousands of participating SilverSneakers® gym locations nationwide, at no extra cost
  • Home fitness kit if you can’t make it to a local gym or exercise class
  • On-demand fitness classes from the comfort of your own home or while traveling

This program helps you make it to and from doctor or hospital appointments without having to rely on family or friends. 

After inpatient hospital stay, Aetna partners with NationsMarket to deliver healthy, precooked meals. The program offers 14 home delivered meals at no extra cost — convenient quality nutrition while you focus on recuperating. 

This program helps you find the resources you need in your daily life. With just one call, a life consultant can help you find local resources to make life easier and support your physical and mental well-being. 

FSBP and Medicare brochure cover

Get to know the Aetna Medicare Advantage plan

FSBP and Medicare: A guide for FSBP retiree health and prescription drug plans. As an FSBP – Aetna Medicare Advantage plan member, you have a suite of programs and services available at no extra cost to you. Download the brochure to learn more.

Benefit comparison

FSBP High Option with Medicare compared to Aetna Medicare Advantage for FSBP

Benefits at a glance

The RCBP High Option column shows benefits when Medicare Parts A and B are your primary coverage.

RCBP waives your calendar year deductible and most copayments and coinsurance, (except for prescription drugs), and pays Medicare’s deductible and coinsurance for services covered by both Medicare and RCBP.

Do not rely on this chart alone. All benefits are fully described in the official Plan Brochure.

Benefit Type Current – FSBP with Medicare FSBP Aetna Medicare Advantage Plan
Annual Part B premium reduction N/A $900 per eligible person ($75 per month)
Deductible $0 $0
Out-of-pocket maximum $5,000 per person (medical and prescription) $0 (medical) $3,500 per person (prescription)
Coinsurance $0, except prescription drugs $0, except prescription drugs
Customer service Calls handled by American Foreign Service Protective Association (AFSPA) Calls handled by Aetna Retiree Service Center representatives
Prior authorization Most services do not require prior authorization Some services require prior authorization** such as, but not limited to: inpatient hospital, outpatient surgery, physical therapy and massage therapy.

Note: This chart assumes Medicare Parts A and B are primary and that covered services are provided by doctors and facilities that participate with Medicare. FSBP does not pay 100% when services are provided by a doctor under a private contract that provides for direct billing and no Medicare coverage. This is also a summary of Medicare features. For more information on Medicare call 1-800-MEDICARE or visit Medicare.gov

Medical coverage

The RCBP High Option column shows benefits when Medicare Parts A and B are your primary coverage.

RCBP waives your calendar year deductible and most copayments and coinsurance, (except for prescription drugs), and pays Medicare’s deductible and coinsurance for services covered by both Medicare and RCBP.

Do not rely on this chart alone. All benefits are fully described in the official Plan Brochure.

Medical Coverage Current – FSBP with Medicare FSBP Aetna Medicare Advantage Plan
Adult annual physical exam $0 $0
Lab, X-ray and other diagnostic tests $0 $0
Primary care and specialty physician visits $0 $0
Chiropractic services $0, up to $75 per visit, up to 50 visits per year. You pay all charges after 50 visits. $0 no maximum
Physical, occupational and speech therapy $0, up to 125 visit combined maximum $0 unlimited visits Prior authorization required
Routine vision exam Not covered $0, limited to 1 routine exam every year
Massage therapy $0, up to maximum of $75 per visit, up to 50 visits per year, no referral required. You pay all charges after 50 visits. $0, up to 50 visits* per year when medically necessary (prior authorization is required). You pay all charges after 50 visits
Inpatient hospital $0 $0
Outpatient hospital $0 $0

Note: This chart assumes Medicare Parts A and B are primary and that covered services are provided by doctors and facilities that participate with Medicare. FSBP does not pay 100% when services are provided by a doctor under a private contract that provides for direct billing and no Medicare coverage. This is also a summary of Medicare features. For more information on Medicare call 1-800-MEDICARE or visit Medicare.gov

Prescription drug benefits

The RCBP High Option column shows benefits when Medicare Parts A and B are your primary coverage.

RCBP waives your calendar year deductible and most copayments and coinsurance, (except for prescription drugs), and pays Medicare’s deductible and coinsurance for services covered by both Medicare and RCBP.

Do not rely on this chart alone. All benefits are fully described in the official Plan Brochure.

Prescription Coverage Current – FSBP with Medicare FSBP Aetna Medicare Advantage Plan
Preferred generic N/A Preferred pharmacies:
$0 (30 days), $0 (90 days)
Standard pharmacies:
$2 (30 days) $4 (90 days)
Generic $10 copay (up to 30 days)
$15 (90 days)
$10 (30 days)
$15 (90 days)
Preferred brand 25% ($30 min; $100 max) (up to 30 days)
$60 (90 days)
$40 (30 days)
$60 (90 days)
Non-preferred brand 35% ($60 min; $200 max) (up to 30 days)
35% ($80 min; $500 max) (90 days)
$75 (30 days)
$150 (90 days)
Specialty generic 25% (up to $150 max) (up to 30 days)
25% (up to $150 max) (90 days)
25%; max $150 (30 days)
25%; max $150 (90 days)
Specialty preferred brand 25% (up to $200 max) (up to 30 days)
25% (up to $200 max) (90 days)
25%; max $150 (30 days)
25%; max $150 (90 days)
Specialty non- preferred brand 35 % (up to $300 max) (up to 30 days)
35 % (up to $300 max) (90 days)
25%; max $150 (30 days)
25%; max $150 (90 days)
Pharmacy Benefit Manager – Different formularies apply Express Scripts CVS Caremark®

Note: This chart assumes Medicare Parts A and B are primary and that covered services are provided by doctors and facilities that participate with Medicare. FSBP does not pay 100% when services are provided by a doctor under a private contract that provides for direct billing and no Medicare coverage. This is also a summary of Medicare features. For more information on Medicare call 1-800-MEDICARE or visit Medicare.gov

Wellness and value-added programs

The RCBP High Option column shows benefits when Medicare Parts A and B are your primary coverage.

RCBP waives your calendar year deductible and most copayments and coinsurance, (except for prescription drugs), and pays Medicare’s deductible and coinsurance for services covered by both Medicare and RCBP.

Do not rely on this chart alone. All benefits are fully described in the official Plan Brochure.

Wellness and value- added programs Current – FSBP with Medicare FSBP Aetna Medicare Advantage Plan
SilverSneakers® Not included Included
Meal benefit program Not included Included – up to 14 meals after discharge per patient
Routine transportation Not included Included – 24 one-way trips up to 60 miles
Healthy Home Visits Not included Included
Resources For Living® Not included Included
Wellness Rewards Earn up to $400 to be deposited in a Wellness Fund account by participating in the Simple Steps to Living Well Together Program Earn up to $400 in gift cards by participating in the Healthy Rewards Program
Over-the-counter supplies Limited to ACA requirements $30 allowance every three months via mail order.

Note: This chart assumes Medicare Parts A and B are primary and that covered services are provided by doctors and facilities that participate with Medicare. FSBP does not pay 100% when services are provided by a doctor under a private contract that provides for direct billing and no Medicare coverage. This is also a summary of Medicare features. For more information on Medicare call 1-800-MEDICARE or visit Medicare.gov

Getting access to Aetna Medicare Advantage

Everyone covered under your plan who has Medicare Parts A and B as primary coverage has the choice to opt into the plan. To complete your enrollment in FSBP — Aetna Medicare Advantage plan:

  1. Please go to AetnaRetireeHealth.com/FSBP or call us at 1-866-241-0262 (TTY: 711), Monday–Friday, 8 AM–8 PM ET.
  2. Provide your Original Medicare effective date for Parts A and B and your Medicare Beneficiary ID. (All available on your Medicare ID card.)

Retiree plan resources to help you with your benefits

FSBP Aetna Medicare Advantage

It’s easy to opt in (with Aetna).

Visit AetnaRetireeHealth.com/FSBP or call 1-866-241-0262 (TTY: 711)

Monday–Friday, 8 AM–8 PM ET

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Get Live Help

Have questions or need help selecting a plan? We offer multiple ways to get live help. Don’t wait, our friendly representatives are here for you.

Aetna Medicare is an HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

SilverSneakers is a registered trademark of Tivity Health, Inc.© Tivity Health, Inc. All rights reserved. Resources For Living is the brand name used for products and services offered through the Aetna group of subsidiary companies. 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. The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary. Aetna Medicare’s pharmacy network includes limited lower cost, preferred pharmacies in applicable areas. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory. Members who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays. 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 days. You can call 1-866-241-0357 (TTY: 711), Monday – Friday 8AM – 8PM ET, 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. Participating physicians, hospitals and other 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. Medicare rules don’t allow earned rewards to be used for Medicare-covered goods or services, including medical or prescription drug out-of-pocket costs. Earned rewards may not be used to pay for medical copays, prescription costs, or any other Medicare covered good or services. Earned rewards may also not be used on alcohol, tobacco or firearms or be converted to cash.

All trademarks and logos are the intellectual property of their respective owners. 

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.

 

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