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 new NALC High Option Plan — Aetna Medicare Advantage.
See the 2024 Summary of Benefits (PDF) for additional plan details.
2024 Important documents 2023 Important documents| 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 |
| Your responsibility | Your responsibility | |
| Annual Deductible | $0 | $0 |
| Annual out-of-pocket maximum | $0 per person (medical) $3,100 per person or $4,000 per family (prescriptions only) | $0 per person (medical) $3,100 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 |
| 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 |
| 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 |
| 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.
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.
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.
Learn more about how to opt in and get startedIf 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 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.
Questions? Call us at 866-241-0262 (TTY:711) Available Monday through Friday, 8 AM to 8 PM ETAetna 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 federal brochure RI 71-009 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 federal brochure RI 71-009. 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. Teladoc® is not available to all members. Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. 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.
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