Good luck with whatever plan you go with.

It’s best not to lump commercial Medicare Advantage plans in with the FEHB MA plans. The FEHB plans are fundamentally different with far fewer limitations and much larger service areas. Here is what Aetna tells providers about claims and contracts: Aetna Guidance to Non-Participating Providers

The Mayo Clinic Florida website Q&A section says....

Does Mayo Clinic accept Medicare?
Yes, Mayo Clinic is a participating Medicare facility in Rochester, Minn., in Florida and at all Mayo Clinic Health System locations.
Mayo Clinic in Arizona does not currently accept assignment for Medicare Part B (medical and professional services) but, does participate in Medicare Part A (hospital services).

It goes on to say......

Does my insurance cover my scheduled appointments?
Please contact your insurance company for benefit-specific information. You may provide your insurance company with Mayo Clinic Tax ID number to determine if Mayo Clinic is in network.

Mayo Clinic's campus in Florida:
Mayo Clinic: Tax ID No. 59-3337028
Mayo Clinic Hospital: Tax ID No. 59-0714831

Since they participate fully with Medicare Parts A and B at the Florida facility, you should be good to go. It should not matter if they have a contract with the Aetna Medicare Plan PPO network or not. Of course, if you care to find out if they do, you can contact Aetna and give them the above tax ID info for Mayo Clinic Florida.

Hope this info helps you with your decision.

The fact is that the FEHB MA plans, including this one, are spinoffs of their respective generic FEHB plans. The way they have been structured, you must first join the generic plan. Then, if you want the MA variant, you complete step two, by which you share the particulars re: your Medicare A+B enrollment. If you do this, you end up in the MA plan variant, which has substantially different benefits. Both the generic and the MA variants of each plan share the same FEHB plan code. You might ask “why don’t they just create a new plan code for each FEHB MA plan?” I don’t know for sure, but suspect that it’s for legal reasons. Perhaps, this process is why they are able to get around the previous requirement that one needed to suspend FEHB in order to join an MA plan.

This brings us to the Checkbook Guide. It needed to identify the features and benefits of each FEHB plan. And each plan has always had its own plan code. Except this year that’s no longer true. So, how could they list plans that are totally different but share the same plan code? The solution was to add an “R” to the end of the plan code for the MA variant. They also added the word “Retirement” to the name to further differentiate the MA variant from the generic version. This is their own unofficial code. Now, they don’t say that this is what they’ve done, but it’s clear (at least to me) that it is. The proof is that the official plan brochures for plans that have MA variants have no plan codes that end with an “R.” They just have the original three generic codes, one each for Self, Self + One and Self + Family. Just try to imagine how the Guide could spell out all these schizophrenic plan details under one listing with one name. Can’t be done.

Now you know why I used the phrase “slightly confusing” to describe plans like these.

Edited by user Saturday, November 21, 2020 11:10:44 PM(UTC)  | Reason: Not specified

Yes. All of the MA info I commented on pertains to the Aetna Medicare Advantage plan. The FEHB brochure offers a mixture of info re: the Medicare and non-Medicare variants of the Aetna Advantage plan. For a more focused look at the answer you want, read the last two links in my post #1 of this topic as well as the link I provided in post #21.

Yes, in that post 21 link, Aetna uses some general language that fits a larger universe of MA plans that contains more than just the one we are interested in here. Some have copayments or coinsurance, but as you see this one definitely does not.

FWIW, here is a copy of a post from a recent similar thread which involved the APWU Advantage plan:

Here is the quote from page 137:'Medicare will
be primary for all Medicare eligible services. Members must use providers who
accept Medicare's assignment.'

One of Checkbook's excellent tenets: 'Trust plan brochures.'

One issue to resolve is that providers who do not accept assignment can charge up to 115% of the Medicare rate. And the plan says there will not be a copay for the Medicare rate, but does not say one way or the other (that I could find) who pays the other possible 15%. It does say, however, on page 90 'We do not waive any costs if the Original Medicare Plan is your primary payor.' So, who is the subscriber that this statement is talking to? The only one I can think of is a retiree who has Parts A and B but has not opted in to the Advantage option of the plan.

Edited by user Monday, November 23, 2020 4:31:59 PM(UTC)  | Reason: added last paragraph

The Aetna Advantage Plan FAQ page contains the following text:

How will the plan lower my Medicare Part B Premium?

Once you have completed the 2-step enrollment process, Medicare will have the necessary information to reduce your Part B premium. Your Social Security account will be credited $75 per month (up to $900 a year). If you pay your premium on a quarterly, semi-annual, or annual basis, you will see a reduction in your premium in the amount equal to the number of months.

While unlikely, it may take a few months to see the credit to either your Social Security check or premium statement, but you will be reimbursed for any credits you did not receive during this waiting period.

The above info can be found on this page link: FAQ Page

That would be logical if that's where Medicare gets deducted.

I’m looking into switching into this plan in the upcoming open season ( currently have BCBS Basic with Medicare) and thought I’d open this thread back up. Anyone have any experience with this plan they could share? Is there a official word on how the reimbursement works for someone not getting SS? I assume they would reimburse my OPM pension…. Thanks!

This plan offers a substantial package of benefits, most of which are obvious, e.g, zero copays, zero co-insurance and zero deductible for medical claims. Other benefits are less obvious but just as substantial. For example, ordinary Medicare Advantage plans generally have what’s called the “donut hole” which affects what a member pays for prescription drugs. Usually, there is a stage one, called the Deductible Stage, in which you pay the full Rx contract price. Then there’s a stage two, called the Initial Coverage Stage, in which the plan pays its share of Rx costs and you pay yours up to a specified annual “total drug costs” limit. In stage three, called the Coverage Gap Stage, aka the donut hole, the plan’s share goes down and your share increases up to a specified annual “total out of pocket cost“ limit. Finally, in stage four, the catastrophic max stage, the plan pays your full Rx cost and you generally pay nothing for the rest of the year.

HOWEVER, under this Aetna Medicare PPO plan, there is no deductible stage. Next, under stage two, your share, which can be up to 25% of the Rx contract price, is capped at $350 per prescription, up to a specified annual ”total drug costs” limit, which in 2021 was $4130. Now, this sounds pretty good, but it leads you to believe that you may be on the hook for some hefty coinsurance costs if you should need a lot of very expensive drugs. But actually you wouldn’t be. Your stage two cost limit is not what you pay out of of pocket, but what the total drug costs happen to be. So, you can reach the stage two limit quicker than you think, especially when the bulk of the cost is being borne by the plan or by others besides yourself. Here is the language that Aetna uses to describe this.

Under the plan, “total drug costs” is the total of all payments made for your covered Part D drugs. It includes:

- What the plan pays.

- What you pay.

- What others (programs or organizations) pay for your drugs.

Next, under stage three, this plan features a special Medicare discount program which essentially eliminates the coverage gap. In other words, your stage three costs are pretty much the same as they are under stage two until your out of pocket costs approach a specified annual catastrophic limit, which in 2021 was $6550. OK, but what about this coverage gap stage? Couldn’t you end up paying up to $6550 per year, even after subsidies? Actually, not very likely. Here’s how Aetna explains this.

“Out-of-pocket costs” include:

- What you pay when you fill or refill a prescription for a covered Part D drug. (This includes payments for your drugs, if any, that are made by family or friends.)

- Payments made for your drugs by any of the following programs or organizations: “Extra Help” from Medicare; Medicare’s Coverage Gap Discount Program; Indian Health Service; AIDS drug assistance programs; most charities; and most State Pharmaceutical Assistance Programs (SPAPs).

Notice how the “out of pocket costs” include the subsidy under the plan’s Medicare discount program. They also include various other subsidies you may qualify for from charitable foundations and government programs. This means that the biggest chunk of the out of pocket cost isn’t actually coming out of YOUR pocket. Which means that if you need REALLY EXPENSIVE drugs, you can reach the catastrophic limit stage without it costing you an arm and a leg. All of which makes the Aetna Medicare Advantage plan even better than I originally thought it to be.

How much a month, self only?