Medicare Advantage Plan
Plan Contact Information
Enrollment
Lynda Bott
Aetna Account Executive
314-920-7962 or lsbott@aetna.com
Krisinda Chadwell
Aetna Account Executive
314-348-7214 or kchadwell@aetna.com
Claims
Call 888-267-2637
When you call, please have your ID number from your Aetna card ready.
Will I get Part A and Part B automatically?
If you’re already getting benefits from Social Security or the Railroad Retirement Board (RRB), you’ll automatically get Part A and Part B starting the first day of the month you turn 65. (If your birthday is on the first day of the month, Part A and Part B starts the first day of the prior month.)
If you’re under 65 and have a disability, you’ll automatically get Part A and Part B after getting 24 months of disability benefits, either from Social Security or certain disability benefits from the RRB.
Will I have to sign up for Part A and/or Part B?
If you’re close to 65, but NOT getting Social Security or RRB benefits, you’ll need to sign up for Medicare. Visit SSA.gov/medicare to apply for Part A and Part B. You can also contact Social Security 3 months before you turn 65 to set up an appointment. If you worked for a railroad, contact the RRB.
In most cases, if you don’t sign up for Part B when you’re first eligible, you may have a delay in getting Medicare Part B coverage in the future because you can only sign up at certain times. You may also have to pay a late enrollment penalty for as long as you have Part B. Call Social Security at 1-800-772-1213
Aetna High Plan and Aetna Low Plan
Once a retiree becomes eligible for Medicare, the Cigna medical plans pay secondary to Medicare Part B, so it is important the retiree enrolls in Part B. Because of this, the District partners with Aetna to provide alternative insurance options that closely mirror the plan design of the Rockwood plan at a much-reduced premium.
There are two Medicare Advantage plans to choose from, the High Plan and the Low Plan. Please see the Overview of Coverage and Premiums in the retiree benefit guide for more information or contact Aetna for a summary plan document.
To enroll in one of the Aetna Advantage Plans for RSD Retirees, you will need to enroll in Medicare A and B. The Rockwood Medicare Advantage Prescription Drug (MAPD) plans includes Part D (Pharmacy) coverage so you cannot enroll in a separate Part D plan. You will need to cancel your Cigna coverage when you enroll in the MAPD plan. For this reason, you will need to contact our local Aetna Account Executive, Lynda Bott at lsbott@aetna.com or 314-920-7962 or Krisinda Chadwell at kchadwell@aetna.com or 314-348-7214, to enroll in the Advantage plan and contact the RSD Benefits office at 636-733-2006 to cancel your Cigna coverage. You can start this process up to 3 months prior to your 65th birthday.
Retirees should contact RSD Benefits at least one month prior to their birthdate with the notification that they are starting a Medicare plan as of the first of the month of their birthday.
Plan Options
2024 HMO High Plan is transitioning to the PPO Extended Service Area starting 1/1/2025.
The network for both PPO ESA (Extended Service Area) plans is the “Aetna Medicare Plan (PPO) with Extended Service Area".
If you are currently enrolled in the HMO plan for 2024 you will automatically be transitioned to the High Plan PPO (ESA). If you would like to change to the Low PPO (ESA) plan you will need to submit an application to change plans.
The below table represents the 2025 plan that starts January 1, 2025
2025 Plan Name |
Aetna Medicare PPO High Plan with Extended Service Area (ESA)
|
Aetna Medicare PPO Low Plan with Extended Service Area (ESA) |
---|---|---|
Plan Monthly Cost | $315.88 Per Month** | $82.16 Per Month** |
Deductible | $0 | $500 |
Out of Pocket Max | $4,150 | $4,150 |
Inpatient Hospital | $150/Day (1-5) | $200/Day (1-5) |
Skilled Nursing Facility | $0/Day (1-20); $40/Day (21-60); $0/Day (61-100) | $20/Day (1-20); $178/Day (21-100) |
Outpatient Services/Surgery | $200 visit | $150 visit |
PCP/Specialist Visits | $15/$25 Copay | $20/$30 Copay |
Diagnostic Radiology | 20% | $120 |
Ambulance | $100 | $120 |
Telehealth/Telemedicine | $15/25 | $20/30 |
Lab | $0 | $0 |
X-Ray | $0 | $0 |
Urgent Care | $25 | $50 |
ER | $50 | $120 |
Emergency Services | Covered whether in or out of network | Covered whether in or out of network |
Other Items
2025 Plan Name |
Aetna Medicare PPO High Plan with Extended Service Area (ESA)
|
Aetna Medicare PPO Low Plan with Extended Service Area (ESA) |
---|---|---|
Prescriptions (standard) | $10/$35/$55/25% | $10/$35/$55/25% |
Retail 90-Day Supply | 2x Copay Tier 1,2,3 (Tier 4 N/A) | 2x Copay Tier 1,2,3 (Tier 4 N/A) |
Gap Coverage |
There is no Gap, only copays listed two boxes above | There is no Gap, only copays listed two boxes above |
Gap Coverage
|
Prescription Out of Pocket Maximum for both plans is $2,000 | Prescription Out of Pocket Maximum for both plans is $2,000 |
Vision Eyewear reimbursement | $100 every 12 months | $265 every 12 months |
Hearing aid reimbursement | $500 every 12 months | $2,500 every 12 months |
Teladoc | $0 | $0 |
Resourses for Living | $0 cost to member EAP (Employee Assistance Program) | $0 cost to member EAP (Employee Assistance Program) |
Silver Sneakers | Free Fitness Program | Free Fitness Program |
Meals | NA | Covered up to 14 meals following an inpatient stay |
Wigs | $400 every 12 months (Prior authorization required) | $400 every 12 months (Prior authorization required) |
Compression Stockings | NA | $0 |
Dental *Dental services must be performed with an Aetna In network dental provider. | $750 max benefit each year, $0 deductible/0% coinsurance, preventative services only (cleanings, exams, & x-rays) | Premier-EPO $1,000 max benefit each year, $0 deductible/0% coinsurance, $25 deductible, 50% coinsurance |
Annual 2024 Cost | $3,790.56 | $985.92 |