Aetna Medicare has Solutions to Help You Save on Prescriptions

12 

Loading....

Loading....

Loading....

Loading....

Loading....

Full text

(1)

Aetna Medicare

has Solutions

to

Help You Save

on Prescriptions

Information Booklet

Aetna Medicare Rx

SM

(2)

Enrolling is Easy

Enrolling

Once you know you qualify for the plan,

follow these two steps to get started.

Review the information included in

this packet.

Complete the enrollment form or

follow your former employer’s

enrollment instructions.

If you are unable to complete the form, call

1-800-307-4830 or TTY/TDD 1-800-628-3323 and

a plan specialist can help you personally.

Eligibility

Just like the Original Medicare Plan, you

must meet certain federal requirements

to join the plan.

You must be entitled to Medicare Part A,

or

You must be enrolled in Medicare Part B,

and

You must reside in the plan service area

offered by your former employer

(3)

Your former employer and Aetna have joined together to offer you a solution to your Medicare prescription drug needs, the Aetna Medicare Rx Plan.

Prices on almost everything keep going up. That includes prescription drugs. With the Aetna Medicare Rx Plan, you can save on medications you are taking now – or those you may need in the future.

Our pharmacy network is nationwide, which makes filling your prescriptions easy. Whether you travel across the U.S. or visit your local pharmacy for your prescriptions, there’s bound to be a pharmacy near by. You can also use Aetna Rx Home Delivery®

for your maintenance medications. Our Aetna Specialty Pharmacy®helps

to fill those hard to find medications. Get convenient and easy to use coverage for your medications.

If you have questions about the coverage or the information inside, call us. A plan specialist is available at 1-800-307- 4830 or TTY/ TDD 1-800-628-3323.

Highlights of the Aetna Rx Plan

Coverage for a wide selection of top generic and brand name medications

used by Medicare members.

Over 57,000 participating pharmacies to get your prescriptions filled.Access the Aetna Rx Home Delivery and Aetna Specialty Pharmacy

for mail-order and hard-to-fill medications.

Dedicated Aetna Medicare plan specialists to answer your questions

and provide assistance with your plan.

Our experience, knowledge, commitment, and extensive pharmacy network are all reasons to learn more about the Aetna Medicare Rx Plan.

Count on Our

PrescriptionDrugCoverage

to Deliver Value

Need to contact us?

1-800-307-4830

1-800-628-3323 (TTY/TDD)

Monday to Friday

8 a.m. to 6 p.m.

(4)

Take a look at our formulary

The Aetna Medicare Preferred Drug List (our formulary) includes medications our plans cover. Our formulary includes drugs likeNexium,®

Lipitor,®

Crestor®

andVytorin®

and many other drugs that you may already be using. There are two types of formularies offered with our plan. The closed formulary covers a specific list of drugs and the open formulary will include a wider choice of possible Part D medications. Both provide prescription drug coverage, just in different ways. Check your Benefits Summary to find out which kind of formulary is included with your plan.

You can get a complete listing of our formulary by visiting us online at www.aetnamedicare.com and using the formulary search engine. Or you can call us at 1-800-307-4830 (TTY/TDD: 1-800-628-3323) and a plan specialist can help you.

Our formulary is developed with help from pharmacists and physicians and has been approved by the federal government. This list provides a choice of quality, cost-effective generic and brand medications approved by the U.S. Food and Drug Administration (FDA).

Get medications you need

Your physician directs your medical care. He or she can prescribe any medication he or she believes is appropriate for you. Coverage is determined according to your Medicare prescription drug plan. Help save money by checking with your doctor to determine if a generic medication from the drug list is right for you.

Drugs on formulary are safe

To be considered for the Aetna Medicare preferred drug list a medication first must be approved by the U.S. Food and Drug Administration (FDA). The FDA is a federal agency charged with promoting and protecting public health by making sure drugs and other products are safe and effective and reach the market in a timely way. Once drugs and other products have entered the market, the FDA monitors them for continued safety. To determine whether an FDA-approved medication belongs on our Aetna Medicare Preferred Drug List, Aetna evaluates its safety, and effectiveness.

Coverage for a Wide

Selection of Generic

and Brand Name Drugs

Medications like

Nexium,

®

Crestor

®

and Lipitor

®

are

covered.

(5)

Our network of pharmacies includes more than 57,000 locations. Get prescriptions filled at CVS, Walgreens, Rite Aid, Target and many other pharmacies throughout the country. Below is a partial listing of network pharmacies. Call us or go to www.aetnamedicare.com for more information.

Our Plans Give You

Convenient Locations

to Have Prescriptions Filled

57,000

participating

pharmacies

Note: If you enroll in an Aetna Medicare Rx Plan, you must use network pharmacies to receive your prescription drug benefit except for non-routine situations and emergency circumstances.

A & H Stores A & P

Ameridrug

Big A Drug Stores Big Y Foods Bi-Lo

BJ’s Wholesale Club Brooks Brookshire Grocery CBC Professional Costco Cummings CVS

D & W Food Centers Discount Drug Mart Duane Reade Eckerd

Emporium Drug Mart Falley’s

Food Lion Fred Meyer Gessler’s

Giant Food Stores Giant Pharmacy H E B

Hartig Drug

Harvest Foods Ingles Markets JH Harvey Co Kash & Karry Kerr Drug Kmart Kroger

Longs Drug Stores Lowe’s Marketplace May’s Drug Stores Medicine Shoppe NCS Healthcare Osco

Pharmacy Express Services Price Chopper Publix Quick Chek Rite Aid Safeway Save Mart Shop’N Save Supervalu Target Walgreens Walmart Winn Dixie

(6)

Simple Options

for

Mail-Order Prescriptions

Safe and Convenient Mail-Order Prescriptions

As a member, you have access to our preferred prescription mail order service, Aetna Rx Home Delivery®, for your maintenance medications.

Aetna Rx Home Delivery® may also help you save on medications for

arthritis, diabetes, heart conditions, asthma, high blood pressure, high cholesterol and other chronic conditions.

Key advantages for using the prescription mail-order service include:

Convenience:Quick and confidential free standard shipping of your

medications to the location of your choice. Save trips to the pharmacy and order a three-month supply of your maintenance medications.

Ease of Use: A simple process makes ordering maintenance

medications easy.

Quality of Service:Registered pharmacists check orders for accuracy and are available 24 hours a day, 7 days a week, in case of emergency.

Savings:The prescription mail order service can provide significant savings for people taking maintenance medications. For select plans, when a three-month supply of medicine is ordered, you make only two co-payments rather than three. Plus our deep discounts on medications help us fill your prescriptions for less andstandard shipping is free.

(7)

Access and Discounts

for Members

Aetna Specialty Pharmacy

Finding specialty medications like injectables or infused medications can be difficult. That’s why we provide our members access to the Aetna Specialty Pharmacy.

Advantages of Aetna Specialty Pharmacy

Convenient, free delivery to your home or doctor’s office.

Educational support 24 hours a day, 7 days a week, by phone to help

you, your family members and caregivers manage specialty medications.

Personal instruction on how to use your medication.

Refrigerated medications are specially packaged and shipped to ensure

they do not move during delivery.

Work closely with your doctor to make sure that you are receiving the

right care, medications and supplies you need.

Discounts on eyeglasses, vitamins, fitness clubs and more

With Aetna Medicare, you get the medications you need – plus a few extra services for no additional cost. You will receive:

Discounts on vision services and eyewear.Membership discounts at fitness centers.

Reduced rates on selected services from acupuncturists, chiropractors,

massage therapists and nutritional counselors.

Savings on vitamins and more than 14,000 natural health and wellness

products including aromatherapy, meditation aids and yoga tools. Call us at 1-800-307-4830 (TTY/TDD: 1-800-628-3323) for more information about these programs.

The products and services described above for discounted products are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services

(8)

Speak to an Aetna Representative

If you need help, call us for answers. A trained plan specialist can talk with you about our plan and the Medicare program. Call our toll-free number at 1-800-307-4830 or TTY/TDD: 1-800-628-3323 for help.

Use the Web for Facts and Savings Tips

You can go online for general benefit information about our plan. Use the formulary search to see which drugs the Aetna Medicare Rx Plan covers. Just go to the Aetna Medicare Rx plan section on the website www.aetnamedicare.com.

You can

Receive

Information and Help

When You Need It

Financial Assistance

Eligibility for financial help with prescription drug coverage is based on guidelines set by the federal government.

You can apply for extra help through the Social Security Administration or a state Medical Assistance Office. Remember, the amount of help received depends on income and resources, and is determined by the federal government. If you think you qualify for help, call the Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778 (24 hours a day/7 days a week) – or visit www.socialsecurity.gov on the Web. You may also go to the Social Security Administration Medicaid office and apply. If you receive extra financial help, you will still need to join a Medicare prescription drug plan in order to receive this assistance.

(9)

Answers to Frequently

Asked Questions

Who is eligible to enroll in a Medicare

prescription drug plan?

You are eligible to enroll in a plan if you:

Are entitled to Medicare benefits under Part A or enrolled in

Part B, and

Reside in the service area of the plan offered by your former employer

After I join an Aetna Medicare Rx Plan, will

there be someone to call if I need help?

Yes. Trained Aetna Medicare Specialists are available to assist our members. So, whether you need information about your coverage, a drug formulary or a pharmacy, we can answer your questions.

Can I get medications filled when I’m traveling

or when I am away from home?

Yes. You can get covered prescriptions filled at any network pharmacy in the United States. In fact, we have over 57,000 locations where you can purchase medications. You can also use the prescription mail order service.

(10)

8

Contact Information

Phone

1-800-307-4830

1-800-628-3323 (TTY/TDD)

Hours of Operation

Monday through Friday 8 a.m. to 6 p.m.

How does Medicare Part D fit in?

Here’s an overview of what the Original Medicare Plan includes:

Part A:The hospital insurance program; the part of Medicare that pays for inpatient hospital, skilled nursing facility and hospice care.

Part B:Coverage for physican, outpatient and preventive services.

Part C:Includes Medicare Advantage Plans (such as HMOs or PPOs)

that provide Part A and B benefits to enrollees, as well as offer optional prescription drug benefits.

Part D:The Medicare prescription drug benefit that started in 2006.

What are the benefits of the Aetna Medicare

Rx Plan?

Coverage for a wide selection of medications used by Medicare members.Safe and convenient mail order service from Aetna Rx Home Delivery®

.

Use of the Aetna Specialty Pharmacy for hard to fill prescriptions.Receive discounts on eyeglasses, vitamins and more as part of your

Aetna membership.

Online formulary search to look up your medications.

Answers to Frequently

Asked Questions

Website

(11)

Glossary of Terms

Beneficiary A person who has health care insurance through the Medicare or

Medicaid program.

Centers for Medicare & The federal agency that runs the Medicare program. In addition,

Medicaid Services (CMS) CMS works with the states to run the Medicaid program. CMS works

to make sure that the beneficiaries in these programs are able to get high quality health care.

Coinsurance Typically, the amount of money that you might pay toward the cost

of a prescription. For instance, if the cost of a prescription was $100.00 and your coinsurance was 25%, you would be responsible for $25.00 of the cost, while your plan would pay the remaining 75%.

Deductible Typically, the amount you pay out of your pocket for covered Part D

drugs before your insurance plan begins to pay.

Copay Typically, an amount you pay that may be a specific dollar amount or

a percentage of the total cost for a service or product. For example, you might be required to pay a $10 copay for a prescription while your insurance pays the rest.

Coverage Gap Commonly referred to as the “donut hole.” It is that portion of the

Part D benefit in which you pay all expenses until you have spent a specific amount for eligible drugs.

Creditable Coverage Prescription drug coverage that is on average at least as good as

standard Medicare Part D coverage.

Donut Hole See “Coverage Gap.”

Dual Eligibles Individuals eligible for both Medicare and Medicaid.

Drug Tiers Cost sharing categories for different types of medications, like

generic, brand and specialty drugs.

Formulary A list of drugs covered under the Aetna Medicare Rx Plan.

Generic Drug A prescription drug that has the same active-ingredient formulas as

the brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Medicare The federal health insurance program for people 65 years of age or

older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD).

Medicare Advantage Program A Medicare program that gives you more choices among health

plans. Everyone who has Medicare Parts A and B is eligible.

Medicare Modernization Act The legislation passed by Congress and signed by President George

W. Bush creating the Medicare Part D prescription drug benefit.

Plan Premium The monthly costs of a plan to pay for your coverage.

Prescription Drug Program Plan coverage offered by private entities like Aetna and approved by

the federal government that provides insurance protection for the costs of prescription medications. Also known as Part D.

(12)

Benefits coverage is provided by Aetna Life Insurance Company, a Medicare Prescription Drug Plan sponsor with a Medicare contract and benefits, limitations, service areas and premiums are subject to change on January 1 of each year.

This material is for informational purposes only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Pharmacy clinical programs such as pre-certification, step therapy, and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional.

Discount programs provide access to discounted prices and are not insured benefits. Vision One is a registered trademark of Cole Vision Corporation.

Value-added services are not offered or guaranteed under our contract with the Medicare program; they are not subject to the Medicare appeals process. They may be subject to Aetna’s grievance process.

You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable, if not otherwise paid for under Medicaid or by another third-party. You must reside in the Aetna Medicare Prescription Drug Plan service area.

Enrollees must use network pharmacies to receive plan benefits except under emergency circumstances. Covered Part D drugs are available at out-of-network pharmacies in special circumstances, including illness while traveling within the United States but outside of the plan’s service area where there is no network pharmacy. An additional cost may be incurred for drugs received at an out-of-network pharmacy.

You may be enrolled in only one Medicare Prescription Drug Plan at a time. If you are enrolled in a Medicare Advantage (MA) Plan, you may not enroll in a Medicare Prescription Drug Plan, unless you are a member of a Private Fee-for-Service MA Plan (PFFS), a Medical Savings Account MA Plan (MSA), or a 1876 Cost Plan. If an individual qualifies for extra help with the Medicare prescription drug plan costs, premium and costs at the pharmacy may be lower. Upon enrollment in the Aetna Medicare plan, Medicare will tell us how much extra help an individual is getting. An individual can obtain information on whether they qualify by calling 1-800-Medicare (1-800-633-4227). TTY/TTD users should call 1-874-486-2048.

Translation of this material into another language may be available. For assistance, please call our plan specialists at 1-800-307-4830 (TTY/TDD: 1-800-682-3323), Monday to Friday, 8 a.m. to 6 p.m.

Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al 1-888-98-AETNA (1-888-982-3862).

© 2006 Aetna Inc.

18.02.369.1 A (8/06) S5810_7D_60806 (8/2006)

Figure

Updating...

References

Updating...