Introducing the FSBP — Aetna Medicare Advantage plan for retirees with Medicare Parts A and B.
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 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)
Plan Details
FSBP — Aetna Medicare Advantage Prescription Drug Documents |
||
|---|---|---|
| Title | Description | Download |
| Pharmacy Tool | Use the Find a Pharmacy Tool | LINK |
| Prescription Drug List | 2024 5 Tier Comprehensive Plus Formulary | |
| Prescription Drug List | 2024 Prior Authorization Details | |
| Prescription Drug List | 2024 Prescription Drug Guide/Formulary | |
| Step Therapy Detail | 2024 Step Therapy Detail | |
| Prescription Drug List | 2024 Formulary Changes | |
| Prescription Drug List | 2024 Non-Part D Rider | |
| Prescription Drug List | 2024 Essential Health Supplemental Benefit | |
| Prescription Drug List | 2023 5 Tier Comprehensive Plus Formulary | |
| Prescription Drug List | 2023 Step Therapy Detail | |
| Prescription Drug List | 2023 Prior Authorization Details | |
Benefit Comparison
The FSBP High Option column shows benefits when Medicare Parts A and B are your primary coverage. FSBP 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 FSBP. Do not rely on this chart alone. All FSBP High Option benefits are fully described in the official Plan Brochure.
| Current – FSBP with Medicare | New – 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. |
| Medical Coverage | Current – FSBP with Medicare | New – 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 $60per 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 $60per visit, up to 50 visits per year, no referral required. You pay all charges after 50 visits. |
$0, up to 50 visits* per year |
| Inpatient hospital | $0 | $0 |
| Outpatient hospital | $0 | $0 |
| Prescription Coverage | Current – FSBP with Medicare | New – FSBP Aetna Medicare Advantage Plan |
|---|---|---|
| Preferred generic | N/A |
Preferred pharmacies: $0 (30 days) $4 (90 days) |
| Generic | $10 copay (up to 30 days) $15 (90 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® |
| Wellness and value- added programs | Current – FSBP with Medicare | New – 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. |
The first column in this chart assumes Medicare Parts A and B are primary and 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.
This is a summary of the Foreign Service Benefit Plan. Before making a final decision, please read the 2023 Official Plan Brochure (RI 72-001). All benefits are subject to the definitions, limitations and exclusions set forth in the official Plan Brochure.
*Please see the Summary of Benefits/Plan Benefit Guide for a list of services that require prior authorization.
**We’ve partnered with American Specialty Health Group (ASH Group) to provide you with therapeutic massage services. As an Aetna Medicare Advantage PPO member, 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. Therapeutic massage treatments must be medically necessary, as determined by ASH Group, and provided by a state licensed massage therapist. We do not cover therapeutic massage for comfort or relaxation purposes.
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.
Y0001_GRP_5192_2023_M
©2022 Aetna Inc.
Quick Links
Plan OverviewPlan Details
Plan FAQs
Express Scripts Medicare Prescription Drug Plan
Provider Search Tool
Full Formulary List
Medicare Brochure
Summary of Benefits Guide
Evidence of Coverage
Rewards Program
Retiree Lifestyle Magazine
Privacy Notice
Forms Library
Over the Counter Supplies
Therapeutic Massage Benefit
View a Webinar