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Aetna Medicare plans

Learn more about the Aetna Medicare plans for 2019

Video Transcript

My name is Jason and I’m here from Aetna to review the 2019 Medicare Advantage benefits offered to the State Health Benefit Program retirees from the State of New Jersey.

There are important updates to your medical coverage for 2019. Your Medicare Advantage plan will continue to be offered but it will now be offered by Aetna.

We are here today to help familiarize you with your 2019 medical Medicare Advantage plan.

If you have any questions after listening to this presentation, please do not hesitate to call Aetna’s dedicated member service line at 1-866-234-3129. I will also give you this number again at the end of the presentation in case you weren’t able to write it down now.

So, what’s happening? You will be enrolled in the Aetna Medicare Advantage plan beginning January 1, 2019.

Aetna was chosen as the health plan because of our comprehensive benefits with cost savings for members. Aetna offers highly rated customer service and extra support programs you don’t get with Original Medicare.

The Aetna Medicare Advantage plan includes:

  • Comprehensive coverage, including 100% coverage for most preventive services
  • Predictable copays for most medical care, the same as your current plan
  • Benefits that complement your doctors’ care and help you manage your total health — physical, emotional and social
  • Even more benefits than your current plan

Sit back and listen and we’ll give you all the necessary information for you to go into 2019 confident your Aetna plan will provide the coverage you need and want.

Who is Aetna?

Aetna is one of the country’s largest health insurers.

We have over 165 years of experience in providing health benefits.

We’re devoted to helping our close to 1.5 million Medicare Advantage members manage and improve their health.

We’re also a highly rated plan based on quality that the Centers for Medicare and Medicaid Services (CMS) measures. CMS is part of the U.S. Department of Health and Human Services and works to ensure all patients get the very best health care.

Medicare Advantage plans get a score or star rating, and Aetna’s national plan received 4 out of 5 stars. This means our plan is highly rated on important measures such as:

  • Member satisfaction and service
  • Helping you stay healthy
  • Helping you manage your long-term conditions

Our mission is dedicated to health.

The Aetna plans are designed to:

  • Build a healthier world — and we know this is especially important in retirement
  • Simplify the health care experience as we want to help you reach your full potential in life

You should know that the plan you have through the State of New Jersey is a highly customized group plan — just for the State of New Jersey members!

Not only has Aetna been around for a long time, 165 years, but we have been dealing with Medicare since the beginning as well. Back in 1966, Aetna paid the first ever Medicare claim. Our Medicare plans are something we take great pride in to this day, ever since that first check in 1966.

You may be wondering: How long has Aetna been providing Medicare Advantage plans to the State of New Jersey specifically?

Aetna has been offering Medicare Advantage plans to State Retirees for the past 10 years. Currently there are more than 26,000 of your fellow State of New Jersey retirees enrolled in an Aetna Medicare Advantage plan.

Our mission since the beginning is dedicated to the health of you and your fellow retirees.

Aetna is leading the way in transitioning from a large insurer to a consumer health care company. We’re dedicated to improving health with a holistic member focus. Our goal is to support every member in achieving their best health. We're working on ways to increase health engagement and continue to personalize the health care experience.

Aetna’s proven care and disease management programs, built into our group Medicare Advantage plans at no extra cost, improve the health of retirees and help manage their long-term care.

We are committed to the State of New Jersey and will continue to support you, as we have your fellow retirees for the past 10 years. We look forward to growing with you and helping you achieve health, happiness and peace of mind.

Not only is Aetna committed to the retirees of the State of New Jersey, but we are committed to the State of New Jersey and the communities within the state.

Over the past two years from 2016 thru 2017, Aetna’s Community Activation & Local Marketing team has donated close to $15k to the communities in New Jersey. The Aetna Foundation has donated close to $1.4m, and all other business entities combined have donated more than $700k to the communities throughout New Jersey. In total, that’s more than $2m donated from Aetna to assist the communities of New Jersey.

In addition to the money, Aetna employees have also donated their time. During the same time period of 2016 thru 2017, Aetna employees have donated close to 20k volunteer hours throughout the state.

We are invested in New Jersey and will continue to be committed to improving the quality of life in the communities where we do business.

Today, we are here to support your health journey with your new Aetna Medicare Advantage plan. We’ll cover the following topics in today’s discussion:

  • How will the Aetna Medicare Advantage plan work
  • How you can continue to see your providers
  • What are your benefits
  • What’s next

After the presentation today we want you to feel comfortable with your health care coverage in 2019, and comfortable that Aetna will take care of you into the future.

We think you’ll find that the Aetna Medicare Advantage plan is simple and easy to use and we’ll show you how.

Medicare Advantage offers you the convenience of ALL of your Medicare Part A and Part B benefits. This is everything you get with Original Medicare PLUS many additional benefits — all in one package.

In addition to coverage for all Medicare-approved services, you will also have the support of Aetna’s Care Advocacy and wellness programs at no additional cost to you.

Aetna’s Medicare Advantage plan is simple. You will have one medical ID card and you will receive one monthly Explanation of Benefits for medical services. All medical claims flow through one source, exactly as they do today.

To be eligible, you have to be enrolled in Parts A and B, and pay your Part B premium just as you do today. You can only be enrolled in one Medicare Advantage plan at a time. If you are currently enrolled in a Part D pharmacy plan that you have purchased on your own, you will now be enrolled in the Part D pharmacy plan offered by Optum® through the State.

Again, we want things to be easy:

  • Your Medicare Advantage plan will have one ID card for all your medical needs.
  • The plan includes more benefits than traditional supplemental plans
  • Included within the plan are care advocacy and wellness benefits that we will discuss shortly
  • Finally, as I mentioned you will receive one monthly Explanation of Benefits for medical services

We know the most important thing for our members when reviewing health plan options is “will my doctor take this plan?”

Let’s review our network details.

Beginning January 1, 2019, you will be enrolled in Aetna’s Medicare Advantage Preferred Provider Organization with an Extended Service Area (PPO ESA). The Aetna PPO ESA plan provides access to providers nationwide.

Your doctor does not have to be in our network. You get the same benefits in or out of network. Even if you visit a provider who is not part of Aetna’s Medicare Advantage network, you will still pay the same cost share as if the provider was part of Aetna’s network. The provider must be eligible to accept Medicare and agree to accept your Aetna plan. Many out of network providers do.

Many times you will have Aetna Medicare network providers available to you. These providers go through an extensive credentialing process with Aetna. This ensures that our members receive the best possible care. Also, these providers are familiar with our Aetna medical management programs and they can help you get the most out of your Aetna Medicare plan.

Aetna Medicare Advantage provides coverage nationwide. When traveling away from home, Aetna will help you find a doctor that accepts the Aetna Medicare Advantage plan.

It also covers you when you are traveling outside the country in case you have an urgent need for medical care.

We encourage everyone to select a primary care physician (PCP), but this is not required.

Aetna’s Medicare Advantage plan is designed to give you the flexibility to see any provider whether or not they are in our network. Again, the provider must be eligible to accept Medicare and agree to accept your Aetna plan. You should know that many doctors do in fact accept Medicare and accept Aetna Medicare Advantage, but there may be some that don’t.

One of the key differences with the customized Aetna Medicare Advantage plan in your area is that it doesn’t cost you more if your provider isn’t in our network. Your cost-share amount (which includes copays and coinsurance) is the same both in and out of network.

You can find additional information about our network and helpful instructions to share with your doctors about our plan, in your informational booklet. You should have received this in the mail.

Although your provider does not have to be in the Aetna network, if they are, you know they have gone through Aetna’s extensive credentialing process. You have two primary ways to find out if your doctor participates with Aetna Medicare or accepts the Aetna Medicare Advantage PPO ESA plan:

  1. First, you can call us if you have questions about certain doctors and/or need help finding a new provider. Our representatives are available Monday – Friday, 8 a.m. to 6 p.m. all time zones. We have a special Aetna member service team that is dedicated to you as a retiree of the State of New Jersey and enrolled in Aetna’s Medicare Advantage plan. They will be happy to help you and will even call your doctor’s office on your behalf to confirm they will accept the plan.
  2. Second, you can visit the custom State of New Jersey website at and click on the provider search where we have an online provider directory. But don’t worry if you don’t see your providers there. Our network is continually growing. You can give us a call and we can help you determine whether your providers accept our plan.

Let’s now review a high level summary of the benefits included with your Aetna Medicare Advantage plan. The cost share is very similar to what you have today, and you should not see a change in cost share when visiting your provider. For a more detailed description of your 2019 benefits, you can look in the informational booklet mailed to you.

Remember, the plan being offered to you through Aetna is a PPO ESA Medicare Advantage plan; therefore, all of the cost share values I will mention will apply to both providers in the Aetna network as well as those providers who are not in the Aetna network.

Let’s now review the benefits and costs for both the $10 and $15 Aetna Medicare Advantage plans. With the exception of the copay amount for primary care and specialty office visits, all other benefits are the same between the two plans.

  • You do not need a referral to visit a provider, you can go to any provider accepting the plan.
  • The plan does not have a deductible.
  • The maximum amount you can pay out of your pocket during calendar year 2019 is $400 for the $10 plan or $1,000 for the $15 plan.
  • Preventive care is covered at 100%, you do not have a cost share for preventive care. Preventive benefits include but are not limited to:
    • Annual wellness exams
    • Routine physical exams
    • Routine mammograms
    • Routine prostate cancer screening exams
    • Routine eye exams
    • Routine hearing exams
  • Your primary care and specialty office visits both have a copay of $10 for the $10 plan, and $15 for the $15 plan. Again, these are the only differences between the two plans, all other benefits are the same.
  • If you happen to have an inpatient hospital stay, you will not have to pay out of pocket. The plan pays 100%.
  • Outpatient surgery is the same, you will not have to pay anything out of your pocket.
  • Your emergency room copay is $75, which is waived if you are admitted to the hospital.
    • This $75 will apply for claims within the United States as well as emergency care outside of the country.
    • If you require emergency care while outside of the country, you will need to pay up front and file a claim upon returning to the United States. You will then be reimbursed up to the $75 you would have paid had you been in the U.S.

We hope this cost share sounds familiar to you! As was mentioned, the cost share will not change from what you have today. You will continue to pay the same amount for services in 2019, as you are currently paying in 2018.

Keep in mind, your pharmacy coverage will continue through OptumRx for 2019. Although Aetna will now provide your medical coverage, there is no change to the pharmacy plans.

Previously I mentioned the simplicity of the plan (one card, keeping your doctors), and we talked about the high level plan design features.

Now, I’d like to share with you some of the support programs you are going to get with the Aetna plan.

At Aetna we value your total health – physical, emotional and social. We want to help you reach your full potential in life, however you define it. So we want to support you wherever you are on your health journey.

  • If you are healthy and do not visit the doctor often, we can simply send reminders for upcoming preventive services you may want to consider.
  • We also have a 24-hour nurse line that you can call to get advice anytime, even when your doctor’s office is closed.
  • Our Healthy Lifestyle Coaching program has licensed health coaches who can work with you to create a program that fits your unique needs. This includes losing weight, quitting smoking or handling stress.
  • Our fall prevention program is a way for us to help with your safety, whether you are prescribed a new medication which causes dizziness, or possibly you are someone with osteoporosis. According to a 2016 study by the National Council on Aging, over 2.5 million emergency room visits per year are attributable to falls with the senior population.
  • For those who want to prevent health challenges from getting worse, we have programs to help with complex conditions such as diabetes and heart disease.
  • For those who have complex medical conditions, we offer nurse case management, programs to help prevent you from being readmitted to the hospital, and Compassionate Care for advanced illnesses.
  • We also offer our Resources For Living® program which provides community referrals for services you may be looking for such as: senior living options, recreation, community service and activities, emergency financial assistance programs, home contractors and home cleaning just to name a few. Although there is no additional cost for you to get information through the Resources For Living program, you will have to pay for the services if you choose to use them.

All of these are included at no additional cost to you and are intended to complement your current health care; it isn’t meant to replace it.

Included in our Medicare Advantage plans is an annual Healthy Home Visit.

This Healthy Home Visit is also completely voluntary. If you choose to take part, a nurse will come to your home to review your health needs and will do a home safety assessment. The visit doesn’t replace care from your doctors, but we work with them to help meet your health needs.

  • The nurse focuses on safety in your home, does a medication review, and asks about your medical and family history.
  • We may recommend any of our support programs I have previously discussed, or others available through the Aetna Medicare Advantage plan that may be helpful for you.
  • With your permission, we communicate the results of our visit with your primary care doctor. This way your doctor can work with you to set up a course of action if necessary.
  • This program is available at no extra cost to you and will help you take advantage of your benefits.

Also included in your Medicare Advantage plan is our voluntary diabetes program which helps many retirees keep their diabetes under control.

In this program, nurses will periodically call you. They:

  • Make sure you are taking your medications correctly
  • Keep track of your blood sugar levels
  • Coach you on making healthy lifestyle choices
  • Answer any questions you may have

We also have dieticians who can give you advice about your special nutrition needs.

At Aetna, our Medicare Advantage plans are designed to help you try to reach your health goals — whatever they are.

As was previously mentioned, we have been serving your fellow State of New Jersey retirees for a decade. Overall, those members currently enrolled in Aetna’s Medicare Advantage plans are very happy with the plan. In fact, based on the annual survey we conduct on those currently enrolled in the Medicare Advantage plans, 97% of them have an overall satisfaction with our plan coverage and benefits.

We have received feedback from some of your fellow State of New Jersey retirees and I’d like to review some of their actual comments regarding Aetna’s Medicare Advantage plans and why they chose it:

  • “I did research. It was recommended from others and the HR where I work. Aetna was their choice.”
  • I chose the Aetna plan “Because of their reputation.”
  • They have a “Wide selection of doctors. All and all it is a very good plan.”
  • “They seem to be concerned about my health issues.”
  • “Aetna takes care of me. I have no problem with them.”
  • “If I have a problem they make a sincere effort to address it.”
  • “I would not choose anything else.”

These are simply a few of the comments we received directly from your fellow retirees in response to the survey they were sent in 2017, asking how they felt about the plan. As you can see, those currently enrolled in the plan are very happy.

So what’s next for you? You do not have to do anything to be enrolled in the new Aetna Medicare Advantage plan. If you are currently enrolled in the $10 Medicare Advantage plan through your current carrier, we will automatically enroll you in the Aetna $10 Medicare Advantage PPO ESA plan. If you are currently enrolled in the $15 Medicare Advantage plan through your current carrier, we will automatically enroll you in the Aetna $15 Medicare Advantage PPO ESA plan.

Again, you do not have to do anything if you want to remain enrolled in the plan!

If you don’t want to be enrolled in the Aetna Medicare Advantage plan through the State of New Jersey, you can opt out of the plan. You must fill out the required Retiree Health Benefit Enrollment and/or Change Form on the Pensions and Benefits website at You may use that form to enroll in another plan, but you will pay higher copays.

We encourage you to give the Aetna plan a try. If you have any questions, do not hesitate to contact the dedicated team at Aetna who is here to help. The number to call to speak to a representative is 1-866-234-3129. Let me give that number one more time. The number to call with questions is 1-866-234-3129.

In addition, if you are someone who likes to go online, the website is available to you. You most likely visited this site today to access this recording. Besides getting access to this recording, you are also able to: research your doctors, get details on the plans available to you and access the NJWell website. You can also get information about your Dental plan options.

After your enrollment in the Aetna Medicare Advantage plan for 2019, you will receive more information in the mail from Aetna including:

  • Plan confirmation letter which confirms your enrollment in the Aetna Medicare Advantage $10 or $15 plan. This letter contains your member ID card and can be used as proof of coverage in the Aetna plan.
  • Aetna’s new member Journey Handbook with information on how to use the plan. It also includes:
    • Evidence of Coverage with details on what the plan covers, how much you pay and more
    • Provider Directory notice to determine if your providers are in the Aetna Medicare Advantage network

But remember, even if your provider is not in the Aetna network, you are still able to see them if they are eligible to receive Medicare payment and willing to accept the plan.

Finally, you will also receive a welcome call after you’ve been enrolled. The welcome call will check to see if you:

  • Have any questions about the transition
  • Want to learn more about the programs that can help you manage a medical condition or situation

We are very excited for you to start enjoying your new plan and all the benefits I’ve gone over today. As I’ve mentioned the Aetna plan will be easy and engaging. We will call you to ease the transition, and get you in the right programs. And most importantly, we’ll be here 24/7 with nurse support, programs and resources.

Be sure to utilize all the information available to you, especially the dedicated representatives who are there to answer your questions. The number again to speak to a representative is 1-866-234-3129.

And don’t forget the website has valuable information as well.

Thank you for your time today. We are confident you will enjoy your Aetna Medicare Advantage plan.

©2018 Aetna Inc.

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Learn more about the Aetna Medicare plans for 2019

Watch the above video to learn more about the SHBP Aetna plan. If you have questions after watching, you can call us at 1-866-234-3129 (TTY: 711), Monday – Friday, 8 a.m. to 6 p.m. ET.
Aetna Medicare plans 2019

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