NALC High Option Plan — Aetna Medicare Advantage
An enhanced level of benefits — for NALC Health Benefit Plan High Option Annuitants with Medicare Parts A and B
As an NALC Health Benefit Plan High Option annuitant, beginning with the 2023 Open Season, you’ll have the opportunity to opt in to a Medicare Advantage plan, called the NALC High Option Plan — Aetna Medicare Advantage.
The NALC High Option Plan — Aetna Medicare Advantage offers extra value with $0 deductibles, prescription drug copays as low as $0 and a $75 monthly Medicare Part B premium reduction.
The NALC High Option Plan — Aetna Medicare Advantage also provides access to additional valuable programs and services such as Healthy Home Visits, home-delivered meals after discharge from an inpatient hospital stay, non-emergency transportation and the SilverSneakers® fitness benefit. In addition, the NALC High Option Plan — Aetna Medicare Advantage provides unlimited physical, occupational and speech therapy visits
If you opt in to the NALC High Option Plan — Aetna Medicare Advantage, Medicare will reduce your monthly Part B premium by $75 a month (up to $900 a year) for each eligible member. If a member does not have Part B paid through Social Security, the credit is taken off their OPM Federal Annuity for Part B or however they pay for Part B, reducing the amount they are billed.
The NALC High Option Plan — Aetna Medicare Advantage is a Medicare Part C plan. Part C combines Parts A and Part B coverage (Original Medicare). It also offers additional benefits that Original Medicare doesn’t cover such as nurse support and wellness programs. The NALC High Option Plan — Aetna Medicare Advantage provides all the benefits of a Medicare Advantage (Medicare Part C) plan and allows you to keep your Federal Employees Health Benefits (FEHB) coverage through the NALC Health Benefit Plan. Once you opt in, you’ll be enrolled and will receive a new NALC High Option Plan — Aetna Medicare Advantage ID card.
You do not need to do anything but use your NALC High Option Plan — Aetna Medicare Advantage ID card when you get care, and let your doctors and pharmacy know you have a new plan.
No. The NALC High Option Plan — Aetna Medicare Advantage is a special offering available to you when you’re enrolled in the NALC Health Benefit Plan High Option through the FEHB program, and are enrolled in Medicare Parts A and B. By opting in to the NALC High Option Plan — Aetna Medicare Advantage, you’ll receive enhanced benefits without suspending your FEHB coverage.
Yes! The NALC High Option Plan — Aetna Medicare Advantage is simply a new enhanced level of benefits available to NALC Health Benefit Plan High Option annuitants. You will continue to be a member of the NALC Health Benefit Plan and can expect the same high level of service that you have experienced with the NALC Health Benefit Plan.
It’s easy. If you’re currently enrolled in NALC Health Benefit Plan High Option and are an annuitant with Medicare Parts A and B as your primary coverage, you can opt in by visiting your retiree benefits website or by calling the Aetna Retiree Solutions service center at 866-241-0262 (TTY:711), Monday–Friday, 8 AM–8 PM ET. Provide your Medicare effective dates for Parts A and B along with your Medicare Number.
If you are not currently enrolled in the NALC Health Benefit Plan High Option, you need to enroll in that plan during FEHB Open Season and then opt in to the NALC High Option Plan — Aetna Medicare Advantage. Visit the Enroll now page.
Coverage begins on January 1, 2023 so long as you opt in by December 13, 2022. If you opt in after that date, but before January 1, 2023, your coverage will still be effective January 1, 2023, but you may not receive all of your plan information before that effective date. You can also opt in any time after January 1, 2023. Your coverage will be effective the first day of the month after your opt-in date.
Be sure to use your NALC High Option Plan — Aetna Medicare Advantage ID card when you get care, and let your doctors and pharmacy know you have a new plan.
If you opt in to the new NALC High Option Plan — Aetna Medicare Advantage and change your mind, you can switch back to your High Option coverage with Original Medicare at any time by sending a request in writing to Aetna, PO Box 14088, Lexington, KY 40512-4088 or calling the Aetna Retiree Solutions service center at 866-241-0262 (TTY:711), to request a disenrollment form.
No. With the NALC High Option Plan — Aetna Medicare Advantage, you have the freedom to see any licensed doctor or hospital as long as they are eligible to receive Medicare payment and accept the NALC High Option Plan — Aetna Medicare Advantage — even if they’re not in the Aetna network.
If you’re not sure if your provider accepts the plan, call Aetna at 866-241-0262 (TTY:711), Monday–Friday, 8 AM–8 PM ET. They’ll confirm or can help you find other nearby doctors or hospitals to meet your needs.
You pay $0 when you visit any provider who is eligible to receive Medicare payment and accepts the NALC High Option Plan — Aetna Medicare Advantage, even if they’re not in the Aetna network.
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 Aetna network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, members please call 866-241-0262 (TTY:711) or consult the online pharmacy directory.
The NALC High Option Plan — Aetna Medicare Advantage uses a formulary list to determine covered medications. You can view the formulary (PDF) here. You can also call Aetna at 866-241-0262 (TTY:711), Monday–Friday, 8 AM–8 PM ET.
The NALC High Option Plan — Aetna Medicare Advantage includes up to $750 in dental benefits for each covered member, including 100% coverage for preventive dental care. Members also get 50% coverage for other covered dental services after a $25 deductible.
Routine eye exams are covered at 100%. Members will also receive an eyewear reimbursement of $100 every 24 months.
To receive reimbursement, submit an itemized billing statement showing proof of payment, along with member name and ID number to the address on the back of the NALC High Option Plan — Aetna Medicare Advantage ID card.
The following programs are included with the NALC High Option Plan — Aetna Medicare Advantage for no extra cost.
SilverSneakers® fitness program: An overall wellness program that may help you improve your health, gain confidence and connect with your community. The program gives you access to exercise equipment, classes and fun social activities at thousands of locations nationwide.
Teladoc®: Licensed doctors that you can meet with online, by phone or mobile app.
Hearing aid reimbursement: Hearing aid reimbursement for annuitants is $2,000/every 36 months (total amount for both ears).
Resources For Living®: This signature program helps you find the resources you need in your daily life. With just one call, a life consultant can help you find local resources to make life easier and more enjoyable. There is no cost for the Resources For Living program; you only pay the cost of any services you choose to use.
Non-emergency transportation program: A program that provides you with options to make it to and from doctor or hospital appointments without always having to rely on family or friends.
Meal benefit program: We offer a meal benefit through Aetna’s relationship with GA Foods for members recently discharged from an inpatient hospital stay. The program offers 14 home delivered meals, which provides added convenience for when making a meal is a difficult option.
If you have questions about any of these programs, call Aetna at 866-241-0262 (TTY:711), Monday–Friday, 8 AM–8 PM ET.
Health advocacy programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.
No, manufacturer coupons and copay assist cards cannot be combined with the Medicare discounts.
No, you continue to pay your NALC Health Benefit Plan High Option premium. For 2023 that is:
| NALC Health Benefit Plan High Option | Code | Monthly Premium |
|---|---|---|
| Self only: | 321 | $223.12 |
| Self plus one: | 323 | $523.75 |
| Self and family: | 322 | $457.82 |
