Aetna Health Insurance Plan Options - Post-65 Plans

Private Fee-for-Service (PFFS) Plans

These are Medicare Advantage plans that fall under Part C of the Medicare Program.  Medicare Advantage Plans are approved by Medicare and run by private companies.  When you enroll in this type of plan you are still in Medicare, but your Medicare Advantage Plan will be providing coverage for all of your Part A and Part B services. Unlike the two Medicare Supplement Plans, you have no Medicare Parts A and B deductibles to pay.  There is only the PFFS deductible, $300 and $500 respectively for PFFS plans 1 and 2. 

For example, if you go to the a physician who charges $100, you will first need to satisfy the PFFS plan deductible ($300 for plan 1 and $500 for plan 2).   Then, for PFFS Plan 1, Aetna would pay 85% and you would pay 15%, or $15.   For PFFS Plan 2, Aetna would pay 80% and you would pay 20%, or $20. 

In PFFS plans, you pay more initially for the kinds of expenses that Medicare Parts A and B cover, but the premium you pay for comparable coverage may well be significantly lower.  PFFS plans also offer much more generous preventive care, paying 100% for such services as annual physicals, routine gynecological or prostate exams, bone density tests, and colorectal cancer screening. The annual out-of-pocket maximum for PFFS Plan 1 is $2,750 and for PFFS Plan 2, it’s $3,500. 

NOTE:  Be sure to check with your medical provider to see if he/she accepts Private Fee-for Service plans.  Many providers nationwide accept PFFS plans, but you need to be sure. 

The PFFS Plan Provisions

The chart below provides a snapshot of how all four of the Emeriti medical plans compare with one another:

For a detailed comparision of the provisions for all the medical options, click here.

To learn more about your 2008 Medicare benefits, review The A, B, C, Ds of Medicare.

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How to Begin Thinking About Your Medical Options

When you think about your medical options, consider two important factors critical to cost and coverage.  First, weigh the premium cost for each plan.  Higher premiums usually result in a richer level of insurance coverage and lower out-of-pocket limits, but you pay the higher premium whether you use the coverage or not.  If you choose a plan with a higher premium, your out-of-pocket expenditures are usually capped at a lower dollar amount than for a plan with a lower premium.  So you will want to choose a plan at the premium level (and coverage level) appropriate for your expected usage.

To calculate the monthly premiums for the different 2008 Emeriti Health Insurance Plan Options, use the Emeriti Online Premium Rate Guide.

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The Emeriti Program provides these distinctive features:

• Catastrophic protection
• A choice of Medicare-approved Part D prescription drug coverages
• Coverage of any doctor or facility that accepts Medicare
• National access to insurance
• Annual choice among Emeriti Health Insurance Plan Options
• Preventive care
• Urgent or emergency coverage for up to six months while traveling abroad.

One of the key benefits of the Program is that you can choose the type and level of coverage for your needs this year, and then choose a different combination next year (for 2009), if your needs change.  

For more information, call the Emeriti Service Center at 1-866-EMERITI (1-866-363-7484).

Aetna Special Programs

As Aetna members, you and your covered dependents may take advantage of special programs that address specific health conditions and needs. Click on the link(s) below to learn more, or click here for a full description of each program.

• Alternative Health Care Program – discounts on alternative therapies (such as acupuncture), vitamins and nutritional supplements, and natural products (such as aromatherapy, foot care and body care products).
• Fitness Program – discounts on health club memberships and certain exercise equipment through GlobalFit™.
• National Medical Excellence Program^® – support care coordination and other services when you or a covered family member needs an organ transplant or other complex medical procedure. For more information about the National Medical Excellence Program (including how to participate), call the toll-free Member Services number on your Aetna ID card.
• National Advantage Program – special rates and discounts with doctors, hospitals and ancillary providers.
• Vision One^® Discount Program – discounts on eye care products, including eyeglasses, contact lenses and solution, non-prescription sunglasses and other eye care accessories, and LASIK surgery.
• Women's Health Program – benefits that focus on the unique health care needs of women; for example, annual OB/GYN exams and cancer screenings.
• Informed Health Line – toll-free access to nurses who can provide information on medical conditions and treatment options, plus help with questions for your doctor.

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Aetna provides all coverage for institutions and their retirees in 48 states and the District of Columbia. For institutions and their retirees in Minnesota, HealthPartners provides comprehensive coverage, and Aetna provides prescription drug only plans. For institutions in Minnesota, and their retirees residing in Minnesota, HealthPartners provides comprehensive coverage, and Aetna provides a prescription drug-only plan. Click here to see the HealthPartners Freedom Plans available in Minnesota. If your institution has fewer than 50 employees, your Emeriti insurance option will be limited to a separate insurance offering mandated by your state insurance department as part of small group insurance reform. Please call an Emeriti Specialist from Aetna to find out what insurance coverage is available to you.