This FSBP Retiree webinar will give an overview of our plan designed for members who have Medicare Parts A and B as their primary coverage.
Thank you for joining us on our webinar today. We will cover the Foreign Service Benefit Plan, Aetna Medicare Advantage Plan, a new plan designed for FSBP retirees with Medicare Parts A and B.
On this webinar, we’ll cover and rolling in Medicare, the parts of Medicare, Aetna Medicare Advantage Plan for FSBP. We’ll look at your benefits at a glance, wellness programs and support, how to opt in, then we’ll finally summarize and then give you information about how to reach out should you have more questions.
When talking about retirement, it’s important to talk about Medicare. If you already have Medicare, this slide will not apply to you. You can enroll in Medicare without penalty at two times. The first is during your initial election period or IEP. Your IEP occurs three months before, the month of, and three months after your 65th birthday. If you’re still receiving your insurance through active employment when you’re 65, you do not need to enroll. You will get a special election, or SEP, of eight months that begins when you stop receiving insurance through active employment. It begins whenever the primary enrollee on your insurance, you or your spouse, stops working. If you enroll outside of one of these periods, you must enroll during the Medicare general enrollment between January 1 and March 31 each year and may be subject to late enrollment penalties.
Here’s a breakdown of Medicare Parts A and B. Medicare Part A is part of original Medicare and provides hospital insurance. Part A is free for those who have paid Medicare taxes while working, already receive social security benefits or have a spouse with Medicare covered employment. Now, if you don’t qualify to get Part A for free, then you can purchase it for a monthly premium, subject to late enrollment fee. This coverage is going to help cover the costs of services like inpatient hospital, skilled nursing, home healthcare and hospice. Part A can have substantial out-of-pocket costs, such as an annual deductible and co-payments depending on the duration of your care.
Medicare Part C, or Medicare Advantage, is an optional part that is available for purchase for a monthly premium from private insurance companies. You must have Parts A and B to get a Part C plan. Now, these plans are becoming an option now through FEHB and we’ll talk about them more in a bit, but they are plans that cover everything original Medicare covers, with additional benefits.
Medicare Part D is additional coverage for prescription drugs. At this point, all Medicare Advantage or Part C plans offered through FEHB include prescription drug coverage equal to or better than what Medicare Part D would provide. And if your income is above a certain limit, you may be required to pay an income-related monthly adjustment as we mentioned, or IRMA, to the government. This is in addition to the standard premium. To opt in to the FSBP Aetna Medicare Advantage Plan, you must reside in the 50 United States. FSBP covers only urgent and emergency overseas care.
Now, let’s take a look at your benefits at a glance. On the far left column, you’ll see the benefits listed. In the middle column, you’ll see how those benefits are under the FSBP with Medicare. And then on the far right column, how those benefits are under the FSBP Aetna Medicare Advantage plan. Under FSBP Medicare, you do not have an annual Medicare Part B premium reduction feature. You do have that under the FSBP Aetna Medicare Advantage plan, and that would be $900 per eligible person or $75 per month. Your annual deductible remains at $0 for both plans. Your annual out of pocket maximum is $5,000 per person for both medical and prescription drugs under FSBP with Medicare, and that’s different under the FSBP Aetna Medicare Advantage Plan, being $0 for medical and a reduction to $3,500 per person for prescription drugs.
Co-insurance remains the same at $0, except for prescription drugs, and that applies to both plans. If you opt in to the FSBP Medicare Advantage Plan, customer service is handled by the Aetna Retiree Service Center. Customer service will no longer be handled by the American Foreign Service Protective Association.
Now, another important point is that currently, if you have Medicare Parts A and B as primary, most services do not require prior authorization as you can see in that middle column there at the bottom. Now, if you opt in to the FSBP Medicare Advantage plan, some services do require prior authorization, such as, but not limited to, inpatient hospital, outpatient surgery, physical therapy, and massage therapy.
Let’s take a look at what you pay for medical coverage under each plan. Adult annual physical examinations are $0 under both plans. Lab X-rays and other diagnostic tests are also $0 under both plans. Your primary care and specialty physician visits are $0 under both plans.
Now, your chiropractic services under FSBP with Medicare, you pay $0 up to a maximum of $60 per visit, up to 50 visits per year, and you pay all charges after 50 visits. Under FSBP Aetna Medicare Advantage Plan, that’s $0 with no maximum. Again, that’s for chiropractic services. Physical, occupational and speech therapy is $0 up to 125 visits combined maximum. And under the FSBP Aetna Medicare Advantage plan, that is $0, unlimited visits, prior authorization required.
Routine vision examinations are not covered under FSBP with Medicare. Under FSBP Aetna Medicare Advantage, you’ll get one routine exam every year at $0. Massage therapy, that’s $0 with a maximum of $60 per visit, up to 50 visits per year, no referral required, and you pay all charges after 50 visits. Again, that’s under FSBP with Medicare. Shifting over to FSBP Aetna Medicare Advantage, that’s $0 up to 50 visits per year when medically necessary, and you pay all charges after 50 visits.
So, if you opt in to FSBP Medicare Advantage Plan, massage therapy is handled a little differently. We’ve partnered with American Specialty Health Group to provide you with therapeutic massage services. You can visit providers in and out of the ASH network at the same cost share, as long as they accept Medicare and your Aetna plan. As I mentioned, it’s medically necessary and therapeutic massage treatments must be medically necessary as determined by ASH group and provided by a state license massage therapist. Again, we do not cover therapeutic massage for comfort or relaxation purposes, so I wanted make sure that that was clear. For both inpatient hospital and outpatient hospital services, those are both $0 under both plans.
Now, let’s look at your prescription coverage. Preferred generic is not available under FSBP with Medicare. In FSBP Aetna Medicare Advantage, you have an option of preferred and standard pharmacies. In the preferred pharmacy, you have a $0 copay for both 30 days and 90 day supplies. In a standard pharmacy, it’s $2 for a 30 day supply and $4 for 90 days. For generic drugs, in FSBP with Medicare, it’s a copay of $10 for 30 days and $15 for 90 days, and a $15 copay for 90 days under FSBP with Aetna Medicare Advantage.
For preferred brand, it’s 25% co-insurance, with a $30 minimum and a maximum of $200 for a 30 day supply, and you have a copay of $60 for a 90 day supply. Again, that’s for preferred brand under your FSBP with Medicare. Now, in FSBP Aetna Medicare Advantage, you’re looking at a $40 copay for 30 days and $60 copay for 90 days, a little bit more simplified.
For non-preferred brand, you’re looking at a co-insurance of 35%, a $60 minimum with a $200 maximum for a 30 day supply, a 35% co-insurance with $80 minimum and $500 maximum for a 90 day supply. Or looking over at the FSBP Aetna Medicare Advantage plan for non-preferred brand, that is $75 for 30 day supply and $150 for a 90 day supply.
Under FSBP with Medicare for specialty generic, you’re looking at 25% co-insurance with $150 maximum for both 30 and 90 day supplies. Specialty preferred brand under the same plan is 25% co-insurance and a $200 maximum for both 30 and 90 day supplies. Now, when you shift over for those tiers of drug under FSBP Aetna Medicare Advantage Plan for both specialty generic and specialty preferred brand, you’re looking at a 25% co-insurance with a maximum of $150 for both 30 days and 90 day supply.
Moving over to specialty non-preferred brands, you’re looking at a 35% co-insurance with $300 maximum for both 30 and 90 days. Under FSP Medicare and under Aetna Medicare Advantage, you’re looking at 25% with a maximum of $150 for both 30 and 90 day supplies. Now, if you opt into the FSBP Aetna Medicare Advantage Plan, your pharmacy benefit manager will change from Express Scripts to CVS Caremark. It’s also important that you check the FSBP Aetna Medicare Advantage Prescription formulary to confirm your cost for your prescription, since it is different than the formulary you use today.
Let’s briefly look at the wellness and added programs under each plan. In the FSBP Aetna Medicare Advantage Plan, included are SilverSneakers fitness, meal benefit program, routine transportation, healthy home visits, and the Resources for Living program. These are not included in FSBP with Medicare. For wellness rewards, you can earn up to $400 to be deposited in a wellness fund by participating in the Simple Steps to Living Well Together program in FSBP with Medicare.
Wellness Rewards for FSBP Medicare Advantage are regulated by the Centers for Medicare and Medicaid Services, you can earn up to $400 in gift cards by participating in the FSBP Aetna Medicare Advantage Health Rewards Program. Over-the-counter supplies, these are limited to ACA requirements under FSBP with Medicare FSBP Aetna Medicare Advantage members will receive $30 to spend every three months. Your over-the-counter allowance can be used on items like pain relief, cold and allergy remedies, first aid supplies, dental and eye care, vitamins and minerals, and even personal care items like sunscreen, lotions, and even cotton swabs.
Most plans offered through FEHB require cost sharing. Cost sharing means you might pay deductibles, co-insurance, and copays when you visit healthcare providers, and we all know this can add up. With this plan, we’re combining both FSBP and the Aetna FEHB presence, along with the cost savings of a Medicare Advantage plan with prescription drug coverage. The FSBP Medicare Advantage Plan provides additional health services that help differentiate it from the FSBP plan paired with original Medicare. These health services include unlimited enhanced chiropractic services at $0 and up to 40 visits of acupuncture at $0. Foot orthotics, compression stockings and routine podiatry care are all at $0. At no additional costs, these services can be used freely to help when needed. Unlike FSBP with original Medicare that offers no routine vision exams, the FSBP Medicare Advantage plan covers one routine vision exam at $0.
When you enroll in FSBP Aetna Medicare Advantage, you’ll have access to programs like Teladoc, a virtual option that provides added convenience for members seeking care. It can be used online, by phone, or through their mobile app. You’ll be connected with US board certified, state licensed healthcare professionals. Teladoc currently has over 700 available providers. There’s a hearing aid reimbursement for members to help pay for the tools needed to engage and communicate with the world around us. Reimbursement is $4,000 every three years. Through the Resources for Living Program, members can find help to locate the resources they need in their daily lives. With just one call, a live consultant can help with things like finding contractors to do work around the house, researching senior housing and adult daycare, gathering lists of activities at local senior centers and assisting with emergency needs.
The non-emergency transportation program ensures that retirees can make it to and from their doctor or hospital appointments safely without having to rely on family or friends. At no additional cost, we provide 24 one-way trips within 60 miles of the starting point. After a hospital stay, Aetna offers a meal benefit program through our relationship with GA Foods. The program offers home delivered meals at no additional cost. You’ll get 14 precooked meals, two per day, for seven days.
And finally, SilverSneakers is an overall wellness program that helps members improve their health to live the life they love. The program gives members access to exercise equipment, classes, and social activities at thousands of locations nationwide. SilverSneakers also offers live and on-demand classes.
So, how to enroll in Aetna Medicare Advantage? It’s easy to opt in. To complete your enrollment, go to AetnaRetireeHealth.com/FSBP or call the Aetna Retiree Solutions Service Center at 1-866-241-0262, Monday through Friday, 8:00 AM through 8:00 PM Eastern Time. You’ll be asked to provide your Medicare Parts A and B effective dates and your Medicare number.
So, let’s take a look at the highlights. On this plan, you’ll get low premiums and out of pocket costs, a $900 Medicare Part B premium reduction per year for eligible members, routine vision coverage and hearing aid reimbursement. Unlimited chiropractor visits, prescription copays as low as $0 from preferred pharmacies, added programs to keep you healthy, such as SilverSneakers, nationwide providers and no referrals and much more. Get the retirement you deserve.
So, we’ve gone over a lot of information, but it doesn’t end here. We’re available to help you research and review. We’ll answer your questions and help you figure things out. Visit our website to learn more and connect with our team. Don’t hesitate to start up an online chat about anything you need to know when shopping for your health plan. For more than a quick chat, schedule a one-on-one appointment with a licensed team member to talk about your healthcare choices. You can even hand pick the person you’d like to meet with before your session.
Tune in for live interactive webinars hosted by the Aetna licensed Federal team. Sign up and learn about the different health plan options and get answers to your questions. If you’re the type of person who likes to figure things out for yourself, then you’re in luck. You don’t have to talk to anyone to understand your plan options. You can access plenty of features on your own. Our FSBPhealth.com website is where you can go for all your plan brochures, as well as detailed information, online directories, and access to your secure member website. That concludes our webinar today. Thank you for joining us.
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.
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