Aetna Medicare Rx® Plan (PDP)
What it is:
This is an Aetna Medicare prescription drug plan. It provides coverage that helps you pay the cost of prescription drugs.
How it works:
You can fill prescriptions at more than 60,000 network pharmacy locations all over the country or access Aetna Rx Home Delivery®.
The plan can also be combined with Aetna MedicareSM RX (PDP) for prescription drug coverage. The difference between the Aetna MedicareSM Plan (PPO) with an Extended Service Area (ESA) combined with Aetna Medicare Rx® (PDP) and the Aetna Golden MedicareSMPlan (HMO) with prescription drug coverage is that the HMO requires you to select a primary care physician (PCP) from the plan’s network and to receive referrals for your care in most cases. The PPO Aetna Medicare Plan (PPO) with Extended Service Area (ESA) allows you the freedom use doctors and hospitals in or out of the plan’s nationwide network, you’ll pay only the in-network cost-sharing amount. If you use a non-network provider, they must accept the PPO ESA plan and be eligible to receive Medicare payment.
- Coverage for a wide selection of top generic and brand-name Part D prescription drugs used by Medicare members.
- More than 65,000 participating pharmacies to get your prescriptions filled.
- Access to Aetna Rx Home Delivery® for mail order and Aetna Specialty Pharmacy® for hard-to-fill prescription drugs
- Dedicated Aetna Medicare plan specialists can answer your questions and provide assistance with your plan.
Aetna Rx Home Delivery® service
You can order up to a 90-day supply of prescription drugs delivered to your home or another location of your choice with no additional cost for standard shipping.
Aetna Specialty Pharmacy®
You can get:
- free, confidential delivery at home or any other location you choose
- safe, fast delivery
- refrigerated, insulated packaging of your prescriptions
- 24/7 phone support
- free, standard supplies for self-injectable prescription drugs
- educational materials
- coordination of home health care services
What you should know:
- Check your plan documents to see which formulary is included with your plan.
Some retirees will find that certain prescription drugs that were covered in 2013 are not included in the 2014 formulary.
- A formulary is a list of covered drugs selected by Aetna Medicare in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. Aetna Medicare will generally cover the drugs listed in the formulary as long as the drug is medically necessary, the prescription is filled at an Aetna Medicare network pharmacy, and other plan rules are followed.
Changes in formulary can include replacement of some brand-name prescription drugs with new generic prescription drugs, or replacement of some expensive drugs with less costly drugs that have been shown to work just as well or better. Additionally, certain drugs that were covered in 2013 without a restriction may now include a restriction. Restrictions can include a requirement to get plan approval in advance or to try a different drug first to see how well it works. Restrictions can also include limits on the quantity of the drug that the plan will cover.
Retirees are encouraged to check to see if any of these changes affect the drugs they use by reviewing the Drug List to make sure that is contains the drugs they take, for changes in requirements, or limits on coverage.
- The Medicare Coverage Gap Discount Program will provide manufacturer discounts on brand-name prescription drugs to Part D enrollees who have reached the coverage gap and are not already receiving “Financial Assistance.” Your plan benefits information displays your cost sharing before any applicable discount for brand drugs during the coverage gap phase of the plan.
Learn more about the Aetna Medicare Rx® Plan (PDP) plan benefits
Are there special discounts, programs and services offered?
Yes! Your RHA plan offers a variety of discounts, programs and services that help you get well and stay healthy. They include:
Health and Wellness Discounts
- The ChooseHealthy®** program: Get a discount off standard charges for acupuncture, chiropractic, massage therapy and nutrition services. Also save off the manufacturer’s suggested retail price on health and wellness products.
- You must have a valid Aetna ID card to receive the discounts from participating natural therapy professionals.
- Natural therapy professionals are located in all 50 states plus Washington, D.C.
- Vital Health Network (VHN): Save off the retail price of an online consultation with a VHN doctor for one topic. Save additionally off the retail price for an online consultation for additional topics.
At home products - Get discounts on products and services for your home and family, such as the Omron 7 Series™ Upper Arm Blood Pressure Monitor. You can track your blood pressure when you need to, accurately and easily.
Books - Save on books, DVDs and more through the American Cancer Society Bookstore, the Mayo Clinic Bookstore and Pranamaya.
Fitness - Save on gym memberships* and name-brand home fitness and nutrition products that support your healthy lifestyle with services provided by GlobalFit®.
Hearing - Get discounts on hearing exams, hearing aids, batteries, repairs and other hearing aid services. You can also get these discounts even though you have a Hearing Aid Reimbursement benefit. Check your plan requirements first.
Natural products and services - Save on specialty health care products and services, including online consultations.
Oral health care - Get discounts on Waterpik® water jet flossers and Epic Dental cavity-fighting products.
Vision - Save on eye exams, frames, lenses, contact lenses and solutions, LASIK surgery, sunglasses and more. You can also get these discounts even though you have an Eyewear Reimbursement benefit. Check your plan requirements first.
Weight management - Get discounts on the CalorieKing® Program*** and products, Jenny Craig® weight loss programs†, and Nutrisystem® weight loss meal plans.††
* Participation is for new gym members only. If you belong to a gym now or belonged recently, call GlobalFit to see if a discount applies.
** The ChooseHealthy program is made available through American Specialty Health Systems, Inc. (ASH Systems), a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a federally registered trademark of ASH and used with permission herein.
*** If you're already a CalorieKing member and want to get the Aetna discounted membership price, you will need to terminate your current CalorieKing Account and rejoin.
† Plus the cost of food. Plus the cost of shipping, (if applicable). Offer applies to initial enrollment fee only and is valid only at participating Centers and through Jenny Craig At Home. Each offer is a separate offer and can be used only once per Member. No cash value. Restrictions apply.
†† The Aetna discount offers do not apply to any plan in which you’re already enrolled. To receive the discounted rate, you must wait until your current plan ends.
For more information and access to extra-value discounts, go to Aetna's secure member website and select Coverage & Benefits, then Discounts.
Discount offers provide access to discounted services and are not part of an insured plan or policy. Aetna does not endorse any vendor, product or service associated with these discount offers. Vendors are independent of Aetna, not agents or employees thereof. Discount offers are not guaranteed and may be discontinued at any time. Aetna makes no payment to the discount vendors. The member is responsible for the full cost of the discounted services. Aetna may receive a percentage of the fee you pay to a discount vendor. While this material is believed to be accurate as of the production date, it is subject to change. The products, services and discounts described above 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 may be subject to the Aetna Medicare grievance process.
Helpful Tool - DocFind
- DocFind—If you have an Aetna Medicare Rx (PDP), you have access to this online provider directory, making it easier to find pharmacies; search by name, zip code, city, state, specialty and/ or hospital affiliation.
- In addition to Aetna’s online DocFind tool, Sears Holdings Corporation retirees can also find participating network providers by calling 1-800-248-7227 (TTY: 711), 8 a.m. to 8 p.m., 7 days a week.
* While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Line nurses can provide information on more than 5,000 topics. Contact your doctor first with any questions or concerns regarding your health care needs. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professionals.
- To see what drugs are included in the Aetna Medicare preferred drug list or formulary, please visit www.aetnamedicare.com. Be sure to select “Group Plans” and then “Find Your Prescriptions.
Health Care Reform
The Medicare Coverage Gap Discount Program will provide manufacturer discounts on brand-name prescription drugs to Part D enrollees who have reached the coverage gap and are not already receiving “Financial Assistance.”
Translation of this material into another language may be available. For assistance, please call Member Services at the number listed on the cover letter under “Contact Us.”
Puede estar disponible la traducción de este material en otro idioma. Para asistencia, por favor llame a Servicio al Cliente al teléfono indicado al inicio de este documento bajo “Contáctenos.”
Aetna Medicare is an HMO/PPO/PDP plan with a Medicare contract. Enrollment in Aetna Medicare depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.
Plans are offered by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company (Aetna). Not all health services are covered. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location.
You must have Medicare Part A and/or Part B to enroll in a Medicare prescription drug plan. You must continue to pay your Medicare Part B premium.
Retiree Health Access® reserves the right to change or terminate benefit plans at any time. Retiree Health Access® and RHA® are registered marks of Health Care Policy Roundtable, LLC. Used under license with Health Care Policy Roundtable. All rights reserved.
Retiree Health Plans Powered by Aetna
This material is for informational purposes only. Aetna has established this Web page to provide information to former employees and dependents of Sears Holdings. Sears Holdings is not endorsing any particular carrier or coverage option and encourages retirees to evaluate all coverage options.
Have questions or want to know more about the plans listed
on this site?
Call an Aetna representative at
(TTY: 711) Monday through Friday, 8 a.m. to 6 p.m. ET
Ready to enroll?
Call the Sears Holdings Retiree Service Center at
Monday through Friday, 7 a.m. to 7 p.m. CT