I took advantage of the option to have someone call me. I asked this question and was told that yes there would be an uncharge of IRMAA if you are subject to it. Right now we are not but I do foresee that happening in a year once RMDs happen.

So I've now made about 6 phone calls including being transferred between different parties and no one at Aetna seems to be able to tell me about coverage for the drugs I take. Anyone have any suggestions to find definitive answers? I found that even though my drugs are not on my existing plan's formulary (even for this year) they have been covered so I'm not sure what to think. But again, at this point, I'm figuring it's probably safer to stay with the plan I know, especially since I sometimes travel out of the country for several months at a time and would not want my coverage to be limited to only significant emergencies.

And BTW, the plan covers both emergencies and urgent care overseas. Only routine care is excluded.

I know open season just ended. We stuck with Aetna Direct because we did have a few unanswered questions. I know with this plan you can go "out of network". Basically does that mean we can go to ANY doctor that accepts Medicare assignment? My PCP does not accept Medicare Advantage Plans that are not Johns Hopkins ones. What will happen when I go to the doctor? Will they refuse to see me because they don't accept my insurance? I tried calling the billing office yesterday morning while still open season but was on hold too long so gave up.

Sorry for not getting back to you sooner. With this plan you can go to any provider that accepts Medicare and the plan. With respect to Medicare, that means that it doesn’t matter whether the provider accepts assignment or not. If they do accept assignment, then bills go directly from the provider to the plan. If they do not accept assignment (but they do accept Medicare), then you pay the fee upfront and get reimbursement from the plan. There is always the remote possibility that the provider simply may choose not to accept the plan at all. This is true of any plan as it pertains to out of network providers. But ALL providers are obliged to provide emergency services as needed. For providers that you will see often, it is always best to ask them (before you sign up) if they accept this plan. The same goes for any plan you’re interested in.

You mentioned a particular situation in which a provider decided to be very picky about which plans they would accept. However, in my experience, this has been a non-issue. Everyone that I have gone to, whether in or out of network, has accepted the plan without any questions asked.

It’s normal for folks who have never had an FEHB Medicare Advantage plan to be a little bit anxious about how things work. However, all I can say is that this has been the most effortless plan I’ve ever had. No hassles, no complications, no hours on the phone arguing with customer service reps. And it sure is nice getting all those EOB’s showing zero payment due from the patient.

FEHBP-Aetna Advantage
PPO ESA Plan

Edited by user Thursday, February 10, 2022 5:19:16 PM(UTC)  | Reason: Not specified

Well, as you can see, I dropped off the the third line via an edit, but you beat me to it. The first of the two lines should suffice for them to locate the plan in their data tables. This is the info from the beginning of the card.

To be honest, for the first time around, I always spell out to providers that this is Aetna’s FEHB Medicare Advantage Plan. There is only one such animal.

Edited by user Thursday, February 10, 2022 5:32:18 PM(UTC)  | Reason: Not specified