Welcome Guest! To enable all features please Login or Register.

Notification

Icon
Error

Options
Go to last post Go to first unread
Wendywendy  
#1 Posted : Friday, October 29, 2021 8:54:10 AM(UTC)
Wendywendy

Rank: Newbie

Groups: Registered
Joined: 5/6/2020(UTC)
Posts: 5

Aetna Direct puts my $900 Medicare supplement into a HealthFund, and uses it for pharmacy copays. My drug comes from Aetna CVS Specialty Pharmacy, with a $600 copay. HOWEVER, my drug company’s Copay Assistance Program pays the copay. Meanwhile, Aetna deducts the $600 copay from myHealthFund until it is depleted, and then the drug company gets charged and successfully pays the copay for the rest of the year.

Issue: My Medicare supplement is being used to pay charges already covered by the drug company. I’m out $900 ($1,800 including my husband’s supplement).

Has anyone experienced this before? Hours have been unsuccessfully spent trying to resolve this telephonically with Aetna and experiencing multiple phone transfers to other Aetna and CVS departments. I mailed a letter to Aetna claims HQs in September, but no reply.

Any assistance will be appreciated.

OUtside  
#2 Posted : Friday, October 29, 2021 10:11:18 AM(UTC)

Rank: Senior Member

Groups: Registered
Joined: 8/19/2008(UTC)
Posts: 1,001

Was thanked: 54 time(s) in 51 post(s)
I read this at the plan's web site (https://www.aetnafeds.com/aetna-direct-details.php): if you have Part B, 'You have the option to use your fund to reimburse yourself for your Medicare Part B premium.'

Have you exercised this option?

Edited by user Friday, October 29, 2021 10:12:52 AM(UTC)  | Reason: Not specified

Wendywendy  
#3 Posted : Friday, October 29, 2021 10:41:57 AM(UTC)
Wendywendy

Rank: Newbie

Groups: Registered
Joined: 5/6/2020(UTC)
Posts: 5

Unfortunately, Aetna does not contact you and ask how you would like the fund dollars spent. There is no exercise of an option. If they process a prescription and you owe a copay, the copay is automatically funded through your HealthFund. There is no communication with the enrollee.

If I’m wrong and there is someone at Aetna to talk option exercises with Part B Medicare customers, please share the info.
OUtside  
#4 Posted : Friday, October 29, 2021 4:02:49 PM(UTC)

Rank: Senior Member

Groups: Registered
Joined: 8/19/2008(UTC)
Posts: 1,001

Was thanked: 54 time(s) in 51 post(s)
We are talking about Plan N63, correct? That is Aetna Direct CDHP, which, as far as I know from just reading about it, does not provide a reimbursement of part of the Part B premium as other plans do, for example, Blue Cross Basic provides such a reimbursement.

So, off the top of the head, I think what the plan is saying at the web site which I quoted above, is that the plan will give you a Health Fund whether or not you have Part B, then if you do not use the Health Fund for your health-related expenses, you can opt to reimburse yourself $900 for your Part B premium from the Health Fund. But since your are using the Health Fund to pay health expenses, this would not apply to you.

But you are also asking why the plan charges your Health Fund when the Rx manufacturer has a copay assistance program. The little experience I have with such a program is that the pharmacy may (or may not) accept the payment from the manufacturer at the time the Rx is filled. But it is not always clear how this works, I know of one instance where the pharmacy said they would accept the payment but the manufacturer said the assistance was not available to federal employees or retirees. In this instance, the issue could not be resolved and the retiree ending up taking a different prescription.

Edited by user Friday, October 29, 2021 4:04:57 PM(UTC)  | Reason: Not specified

OUtside  
#5 Posted : Friday, October 29, 2021 8:48:09 PM(UTC)

Rank: Senior Member

Groups: Registered
Joined: 8/19/2008(UTC)
Posts: 1,001

Was thanked: 54 time(s) in 51 post(s)
I found this on page 142 of the plan brochure, I think it explains the answer to your question:

'Some specialty medications may qualify for third-party copayment assistance programs that could
lower your out of-pocket costs for those products. For any such specialty medication where third-party copayment
assistance is used, you shall not receive credit toward your out-of-pocket maximum or deductible for any copayment
or coinsurance amounts that are applied to a manufacturer coupon or rebate.'

And just thinking out loud here, the reason would probably be, suppose it were the other way around and you had available at the end of the year $900 in your Health Fund because the 3rd party had paid for your Rx, you could then opt to receive that amount to cover part of your Part B premium. In a sense, you would have benefitted twice, once when the 3rd party paid for the Rx and a second time when you were reimbursed for part of your Part B premium (and the plan does not reimburse Part B premiums per se).
Wendywendy  
#6 Posted : Sunday, October 31, 2021 8:47:41 AM(UTC)
Wendywendy

Rank: Newbie

Groups: Registered
Joined: 5/6/2020(UTC)
Posts: 5

Thanks for your input. My plan is N63. As we have Original Medicare (A and B), the pharmaceutical deductibles are waived as stated on page 143 of the brochure. I obviously do contribute to my Rx through payment of my monthly premium, and my issue is the HealthFund dollars being used to make a copayment when a third party already covers the copayment. There may be a reasonable explanation for this practice, I just haven’t found anyone to explain it to me.

Bottom line is I’m grateful to Aetna for allowing third party payments as it does not appears that all fed health plans offer this service. Having a third party pay $600 a month for my copay is a blessing. Having to pay the first three months out of my HealthFund (self plus one) ($1,800) knowing third party is waiting to pay, well…ouch.



upandup  
#7 Posted : Sunday, October 31, 2021 3:07:27 PM(UTC)

Rank: Senior Member

Groups: Registered
Joined: 9/25/2010(UTC)
Posts: 812

Was thanked: 17 time(s) in 16 post(s)
Have you filled out the form at https://www.aetnafeds.co...imbursement_gc16515w.pdf
to request reimbursement for Medicare premiums? Filing for that before your prescription copay comes due might be a good strategy in your case.
Wendywendy  
#8 Posted : Monday, November 1, 2021 8:40:22 AM(UTC)
Wendywendy

Rank: Newbie

Groups: Registered
Joined: 5/6/2020(UTC)
Posts: 5

Thank you, that is great advice. Timing of monthly prescription copays versus receipt and processing of a healthfund reimbursements will be an interesting game to play. Great idea, thanks again.
fedspouse  
#9 Posted : Monday, November 1, 2021 12:48:46 PM(UTC)

Rank: Groupie

Groups: Registered
Joined: 2/23/2010(UTC)
Posts: 91

Was thanked: 4 time(s) in 4 post(s)
We have Aetna Direct. So far we have not needed the specialty pharmacy but possibility one of us might. Sorry to hear that they will use up all $1800 when you have a 3rd party to pay the copay.

The form someone posted above is the same form we fill out every year to get reimbursement of Part B premiums. We fill it out at the beginning of the year. Then each month we call in for them to send us a check. Stupid way of doing it . No direct deposit, no automated payment. We were told that some people call every month like us but many others call every few months or even 1x/year (at the end of the year as they won't reimburse before you have actually paid the premium). This form DOES NOT stop them from deducting a pharmacy copay from the fund but just allows them to reimburse your Part B premium AFTER you have paid it. I have had several prescriptions (generic). When I go to the pharmacy they tell me I owe nothing but that is because the small copay was subtracted from my fund.
Wendywendy  
#10 Posted : Monday, November 1, 2021 4:34:57 PM(UTC)
Wendywendy

Rank: Newbie

Groups: Registered
Joined: 5/6/2020(UTC)
Posts: 5

Thank you for your response. I’m CSRS, and am billed and pay for Medicare three months in advance. Currently, I have paid Nov-Jan 2022. My husband’s Medicare is paid through Social Security, and I believe it is paid at the end of the month. So the timing will be critical to beat copay disbursement. But I’m ready!


A note of interest: I received an acknowledgment from Aetna on a letter I sent them on 29 Sep on this issue. The preprinted card said they will be responding soon.

And again, so grateful Aetna Direct will accept third party payments.
Rss Feed  Atom Feed
Users browsing this topic
Guest
Forum Jump  
You cannot post new topics in this forum.
You cannot reply to topics in this forum.
You cannot delete your posts in this forum.
You cannot edit your posts in this forum.
You cannot create polls in this forum.
You cannot vote in polls in this forum.

Powered by YAF 2.1.1 | YAF © 2003-2022, Yet Another Forum.NET
This page was generated in 0.536 seconds.