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.
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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.
- $900 ($75 monthly) Medicare Part B premium reduction for eligible members
- Added programs like SilverSneakers® and Healthy Home Visits
- $0 deductible and coinsurance for medical care
- Prescriptions as low as $0 (be sure to check the formulary to confirm your cost for your prescription)
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
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:
- Please go to AetnaRetireeHealth.com/FSBP or call us at 1-866-241-0262 (TTY: 711), Monday–Friday, 8 AM–8 PM ET.
- 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
Retiree documents
- 2023 Retiree plan brochure PDF - opens in a new window
- 2023 Medicare – Evidence of Coverage PDF - opens in a new window
- 2023 Medicare – Plan Document Notice PDF - opens in a new window
- 2023 Medicare – Schedule of Cost Sharing PDF - opens in a new window
- 2023 Medicare – Summary of Benefits PDF - opens in a new window
Pharmacy Cost Calculator and Locator Tool
Retiree prescription drug information
Claim forms and appeals resources
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
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.
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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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