Aetna Medicare Advantage plan – Plan Details
RCBP offers an Aetna Medicare Advantage Plan (PPO). This plan offers enhanced benefits for retirees who have Medicare Parts A and B as their primary coverage.
How the Plan Works
You’ll have waived cost sharing for deductibles, copayments and coinsurance meaning you’ll pay nothing for most medical care. With Aetna Medicare Advantage for RCBP, members will get enhanced benefits and added programs that aren’t included with RCBP for no additional FEHB premium.
Plan Highlights
- $900 Medicare Part B premium reduction per year for each eligible member
- Added programs such as SilverSneakers®, Healthy Home Visits, nonemergency transportation for medical appointments, meals after a hospital stay and more, at no extra cost
- Unlimited chiropractor visits
- Unlimited physical, occupational and speech therapy visits
- Low prescription copays — as low as $0 from preferred pharmacies and $2 from standard pharmacies (be sure to check the formulary to confirm your cost for your prescription)
- Nationwide doctors (use any doctor who is eligible to receive Medicare payment)
MAPD Plan Documents |
||
|---|---|---|
| Title | Description | Download |
| Pharmacy Tool | Use the Find a Pharmacy Tool | LINK |
| Plan Document | 2024 Annual Notice of Change | |
| Plan Document | 2024 Plan Document Notice | |
| Plan Document | 2024 Evidence of Coverage | |
| Plan Document | 2024 Schedule of Cost Sharing | |
| Prescription Drug List | 2024 GRP Comprehensive Plus (5 tier) Formulary MAPD | |
| Prescription Drug List | 2024 GRP Comprehensive Plus (5 Tier) – Prior Authorization Information | |
| Step Therapy Detail | 2024 GRP Comprehensive Plus (5 Tier) – Step Therapy Information” | |
| Prescription Drug List | 2024 GRP Comprehensive Plus (5 Tier) – Drug List Changes | |
| Prescription Drug List | Non-Part D Supplemental Benefit List | |
| Prescription Drug List | Essential Health Supplemental Benefit List | |
| Prescription Drug List | 2023 5 Tier Comprehensive Plus Formulary – MAPD | |
| Prescription Drug List | 2023 Step Therapy Detail | |
| Prescription Drug List | 2023 GRP Comprehensive Plus (5 Tier) – Prior Authorization Information | |
Benefit Comparison
RCBP with Medicare and Aetna Medicare Advantage for RCBP – benefit comparison
The first column is a summary of the RCBP High Option 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 (RI 72-005).
| RCBP with Medicare | Aetna Medicare Advantage for RCBP | |
|---|---|---|
| Annual Part B premium reduction | N/A | $900 per eligible person |
| Deductible | $0 | $0 |
| Out-of-pocket maximum | $5,000 per person (medical and prescription) | $2,000 per person (prescription only) |
| Coinsurance | $0, except prescription drugs | $0, except prescription drugs |
| Medical Coverage | RCBP with Medicare – you pay | Aetna Medicare Advantage for RCBP – you pay |
|---|---|---|
| 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 | $0 |
| Physical, occupational and speech therapy | $0, up to 90-visit combined maximum | $0, unlimited visits |
| Routine vision exam | $0, up to $45 benefit; then all charges | $0, no maximum |
| Inpatient hospital | $0 | $0 |
| Outpatient hospital | $0 | $0 |
| Prescription Coverage | RCBP with Medicare – you pay | Aetna Medicare Advantage for RCBP – you pay |
|---|---|---|
| Preferred generic | N/A | Preferred pharmacies: $0 (30 days) $0 (90 days) Standard pharmacies: $2 (30 days) $4 (90 days) |
| Generic | 30%; max $7.50 (30 days) $10 (90 days) |
$5 (30 days), $10 (90 days) |
| Preferred brand | 30%; max $200 (30 days) $50 (90 days) |
$35 (30 days), $35 (90 days) |
| Non-preferred brand | 30%; max $200 (30 days) $80 (90 days) |
$40(30 days) $40 (90 days) |
| Specialty generic | $70 (30 days) $100 (90 days) |
$70 (30 days) $100 (90 days) |
| Specialty preferred brand | $90 (30 days) $125 (90 days) |
$70(30 days) $100 (90 days) |
| Specialty non- preferred brand | $120 (30 days) $250 (90 days) |
$70 (30 days) $100 (90 days) |
| Wellness and value- added programs | RCBP with Medicare | Aetna Medicare Advantage for RCBP |
|---|---|---|
| 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 |
| 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 that covered services are provided by doctors and facilities that participate with Medicare. RCBP 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 TTY or visit www.Medicare.gov.
Claim forms and Appeals Resources
Click to view Medicare policies, procedures and claim forms
Click to view resources for Medicare coverage requests, appeals and complaints
Aetna Medicare is a PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. The formulary, provider and/ or pharmacy network may change at any time. You will receive notice when necessary. 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. 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. Plan features and availability may vary by service area. SilverSneakers is a registered trademark of Tivity Health, Inc. © 2021 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. For accommodation of persons with special needs at meetings, call 1-800-638-8432 (TTY: 711).
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Aetna Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice.
This is a summary of the Rural Carrier Benefit Plan. Before making a final decision, please read the 2023 Official Plan Brochure (RI 72-005). All benefits are subject to the definitions, limitations and exclusions set forth in the official Plan Brochure. External websites links are provided for your information and convenience only and does not imply or mean that Aetna endorses the content of such linked websites or third party services. Aetna has no control over the content or materials contained therein. Aetna therefore makes no warranties or representations, express or implied, about such linked websites, the third parties they are owned and operated by, and the information and/or the suitability or quality of the products contained on them.
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. Plan features and availability may vary by service area. SilverSneakers is a registered trademark of Tivity Health, Inc. © 2021 Tivity Health, Inc. All rights reserved.
© 2023 Aetna Inc.
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View the Official Plan Brochure for details about RCBP health benefits plans