Plan FAQs

Select a frequently asked question below for more information.

About the NALC High Option Plan — Aetna Medicare Advantage

As an NALC Health Benefit Plan High Option annuitant, you 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

Once you have completed the two-step enrollment process, Medicare will have the necessary information to reduce the Part B premium for all eligible members on your plan. Your Social Security account will be credited $75 each month (up to $900 a year). Whether you pay your premium on a monthly, quarterly, semi-annual or annual basis, you’ll see a reduction of $75 per month. If you pay your Medicare Part B through your OPM annuity, you will see the credit there.

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 includes Medicare Part D for prescription drug coverage. The plan 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 with prescription drug 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 an 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.

If you are already enrolled in the NALC Health Benefit Plan High Option, there is nothing you need to do in the FEHB Open Season to stay with our Plan.
If you want to opt in to the NALC High Option Plan — Aetna Medicare Advantage, you’ll need to take a second step to opt in as described below.

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 the first day of the month after you opt-in to the NALC High Option Plan — Aetna Medicare Advantage.

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.

You can switch back to your High Option coverage with Original Medicare at any time by completing a disenrollment form (PDF) and sending to Group Aetna Medicare, PO Box 7082, London, KY 40742. If you need the disenrollment form mailed to you call the Aetna Retiree Solutions service center at 866-241-0262 (TTY:711)

Network access

: 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.

Coverage and cost

With NALC High Option Plan — Aetna Medicare Advantage 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.

With NALC High Option Plan — Aetna Medicare Advantage your prescription copays for a 30-day supply will be:

$0 for a preferred generic drug at a preferred pharmacy; $2 at a standard pharmacy
5 percent of cost per covered non-preferred generic drug
20 percent per covered preferred brand-name drug
40 percent per covered non-preferred brand-name drug
25 percent for specialty drugs ($200 maximum)

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.

Yes. Your share of the cost for a 90-day prescription will be:

$0 for a preferred generic drug at a preferred pharmacy, $4 at a standard pharmacy
$10 per covered non-preferred generic drug
$75 per covered preferred brand-name drug
$110 per covered non-preferred brand-name drug
25 percent for specialty drugs ($400 maximum)

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 percent coverage for preventive dental care. Members also get 50 percent coverage for other covered dental services after a $25 deductible.

Routine eye exams are covered at 100 percent. 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 your 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 Health: U.S. licensed doctors that you can meet with by phone, web or mobile app. The doctors can diagnose, treat and prescribe medication when needed.

Hearing aid reimbursement: Hearing aid reimbursement for annuitants is $2,500/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 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 NationsMarket 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 2025 that is:

These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.

Dental plan details.
NALC Health Benefit Plan High Option	Code	Monthly Premium
Self only:	321	294.84
Self plus one:	323	690.54
Self and family:	322	615.20