Plan details

NALC Health Benefit Plan High Option vs. NALC High Option Plan — Aetna Medicare Advantage

Plan details — 2025 Benefit coverage highlights

While federal employees or annuitants are not required to elect any additional parts of Medicare, there are benefits to doing so.

The following charts compare some commonly used services between the existing coverage available under the NALC Health Benefit Plan High Option (for annuitants also enrolled in Medicare Parts A and B) and the NALC High Option Plan — Aetna Medicare Advantage.

See the 2025 Summary of Benefits (PDF) for additional plan details.

2025 Important documents

2025 - Plan Guide (PDF)

2025 - Summary of benefits (PDF)

2025 - Schedule of Cost Sharing (PDF)

2025 - Evidence of Coverage (PDF)

2025 - Annual Notice of Changes (PDF)

2025 - Plan Document Notice (PDF)

2025 Medical coverage

Comparison table of Medical coverage details.
Medical coverage	Existing NALC Health Benefit Plan High Option plus separate enrollment in Medicare (assumes in-network providers are used)*	New NALC High Option Plan — Aetna Medicare Advantage
Medicare Part B Premium Reduction	Each eligible annuitant receives up to a $600 per year Medicare Part B premium reimbursement if enrolled in the SilverScript^® Prescription Drug Plan sponsored by NALC Health Benefit Plan	Each eligible annuitant receives a $900 per year ($75 per month) Medicare Part B premium reduction
not applicable	Your responsibility	Your responsibility
Annual Deductible	$0	$0
Annual out-of-pocket maximum	$0 per person (medical) $2,000 per person, if enrolled in the SilverScript^® Prescription Drug Plan sponsored by the NALC Health Benefit Plan	$0 per person (medical) $2,000 per person (prescriptions only)
Coinsurance	0%, except prescription drugs	$0, except prescription drugs
Primary care and specialty physician visits	$0	$0
Adult annual preventive physical exam	$0	$0
Lab, X-ray and other diagnostic tests	$0	$0
Inpatient hospital	$0	$0
Home health services	$0, limited to 2 hours/day and up to 50 visits/year unless more visits are covered by Medicare	$0, limited to 8 hours per day/35 hours per week
Chiropractic services	$0, Medicare approved – unlimited; Enhanced chiropractic services -- limit 24 visits per year	$0, Medicare approved – unlimited; Enhanced chiropractic services -- limit 25 visits per year
Physical, occupational and speech therapy	$0, limited to 75 visits unless more visits are covered by Medicare	$0, no visit limit
Routine vision exam	Not covered	$0
Outpatient hospital	$0	$0
Emergency Care	$0	$0
Urgent Care	$0	$0
Covered services outside of the United States	Submit itemized bill for reimbursement; benefits subject to the non-PPO plan allowance and deductible	Submit itemized bill for reimbursement; benefits covered the same as within the United States

2025 Prescription coverage

Comparison table of Perescription coverage.
Prescription coverage	Existing NALC Health Benefit Plan High Option plus separate enrollment in Medicare (assumes in-network providers are used)*	New NALC High Option Plan — Aetna Medicare Advantage
Retail pharmacy (30-day supply of a covered drug)	Generic: 10% of cost (hypertension, diabetes, and asthma: 5%) Preferred brand: 20% Non-preferred brand: 40% Specialty: $200	Preferred generic: $0 at preferred pharmacies $2 at standard Generic: 5% Preferred brand: 20% Non-preferred brand: 40% Specialty: 25% ($200 max.)
Mail order pharmacy or retail (90-day supply of a covered drug)	Generic: $10 Preferred brand: $75 Non-preferred brand: $110 Specialty: $400 Hypertension, diabetes, and asthma: Generic: $4 generic Preferred brand: $40 Non-preferred brand: $60	Preferred generic: $0 through preferred retail or mail $4 through standard retail or mail Generic: $10 Preferred brand: $75 Non-preferred brand: $110 Specialty: 25% ($400 max.)

2025 Dental coverage

Comparison table of Dental plan coverage
not applicable	Existing NALC Health Benefit Plan High Option plus separate enrollment in Medicare (assumes in-network providers are used)*	New NALC High Option Plan — Aetna Medicare Advantage
Dental	Not covered	Annual benefit maximum $750 per year for covered services Coverage includes cleanings, checkups, X-rays and comprehensive services
Preventive dental services	Not covered	$0 deductible 0% coinsurance for each dental service
Comprehensive dental services	Not covered	$25 deductible 50% coinsurance for each dental service

2025 Vision coverage

Comparison table of Vision plan coverage
not applicable	Existing NALC Health Benefit Plan High Option plus separate enrollment in Medicare (assumes in-network providers are used)*	New NALC High Option Plan — Aetna Medicare Advantage
Vision	Not covered	$0 routine vision exam $100 eyewear reimbursement every 24 months

2025 Additional benefits

Comparison table of Additional benefits plan details.
not applicable	Existing NALC Health Benefit Plan High Option plus separate enrollment in Medicare (assumes in-network providers are used)*	New NALC High Option Plan — Aetna Medicare Advantage
SilverSneakers^® fitness program	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 each
Resources for Living^® program	Not included	Included
Healthy Home Visit Program	Not included	Included
Wellness rewards program	Included	Included. Earn rewards when you complete important health care activities
Hearing aids	$2,500 every 36 months	$2,500 every 36 months

* The charts above assumes that the items and services are covered by Medicare unless specifically noted otherwise. The middle 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. The last column assumes that you have Medicare Parts A and B and have opted into the NALC High Option Plan — Aetna Medicare Advantage.

**Visit the Prescription benefits page to view preferred and standard pharmacies as well as the prescription drug formulary to determine the cost share for your medication.

Benefits wherever you are

This plan lets you use any doctors and hospitals that are licensed to receive Medicare payment and willing to accept your plan. And with the NALC High Option Plan – Aetna Medicare Advantage, your coverage follows you wherever you travel, nationwide.

View member tools to find a Provider

Opting-in to the NALC High Option Plan – Aetna Medicare Advantage

If you have Medicare Parts A and B as your primary coverage, and you are enrolled in the NALC Health Benefit Plan High Option, you can opt in to the new NALC High Option Plan — Aetna Medicare Advantage. Any dependents not enrolled in NALC High Option Plan — Aetna Medicare Advantage will continue with coverage under the NALC Health Benefit Plan High Option.

To complete your NALC High Option Plan — Aetna Medicare Advantage enrollment once you’re enrolled in the NALC Health Benefit Plan High Option:

Log in to: your retiree benefits website
Or call the Aetna Retiree Solutions service center at 1-866-241-0262 (TTY:711) Monday–Friday, 8 AM–8 PM ET.
Provide the following information:
- Your Medicare Parts A and B effective dates
- Your Medicare number (MBI)

If you opt in to the new NALC High Option Plan — Aetna Medicare Advantage and change your mind, you can switch back to the High Option Plan with Original Medicare at any time by calling the Aetna Retiree Solutions service center at 1-866-241-0262 (TTY:711) to request a disenrollment form.

Once you opt in to the NALC High Option Plan — Aetna Medicare Advantage, be sure to begin using your new Medicare Advantage ID card. Each annuitant and dependent enrolled in the NALC High Option Plan — Aetna Medicare Advantage will receive a new card with a new member ID number to replace your current NALC Health Benefit Plan High Option ID card. Remember to show each of your providers your new Aetna Medicare Advantage ID card at your next visit. You will continue to be a member of the NALC Health Benefit Plan; however, your coverage will be under the NALC High Option Plan — Aetna Medicare Advantage.

Opt in now

Questions? Call us at 1-866-241-0262 (TTY:711)

Available Monday through Friday, 8 AM to 8 PM ET

Aetna Medicare is a PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. This is a brief description of the features of this plan. Before making a final decision, please read the NALC Health Benefit Plan — High Option’s official plan brochure and the NALC High Option Plan — Aetna Medicare Advantage plan documents. All benefits under the NALC Health Benefit Plan — High Option are subject to the definitions, limitations and exclusions set forth in the official plan brochure. The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary. 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. Information is believed to be accurate as of the production date; however, it is subject to change. External websites links are provided for your information and convenience only and do not imply or mean that Aetna or the NALC Health Benefit Plan endorses the content of such linked websites or third-party services. Aetna and the NALC Health Benefit Plan have no control over the content or materials contained therein. Aetna and the NALC Health Benefit Plan therefore make 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. 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. Resources For Living is the brand name used for products and services offered through the Aetna group of subsidiary companies. Vision care providers are contracted through EyeMed® Vision Care. All trademarks and logos are the intellectual property of their respective owners. If you are a non-Postal employee, annuitant, survivor annuitant, or a Spouse Equity or TCC enrollee, you become an associate member of the NALC when you enroll in the NALC Health Benefit Plan, including the NALC High Option Plan — Aetna Medicare Advantage. Associate members will be billed by the National Association of Letter Carriers (the union) for the $36 annual membership fee, which is subject to change.