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
The following chart compares some commonly used prescription benefits 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 new NALC High Option Plan — Aetna Medicare Advantage.
See the 2024 Summary of Benefits (PDF) for additional plan details.
Please note: Manufacturer coupons and copay assist cards cannot be used with the NALC High Option Plan — Aetna Medicare Advantage plan.
Helpful links:| 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:
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:
Preferred brand: $75 Non-preferred brand: $110 Specialty: 25% ($400 max.) |
* The chart 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.
** 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.
