Aetna Golden MedicareSM Plan (HMO)

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What it is:

This is an Aetna Medicare Advantage health maintenance organization plan (HMO) that includes Aetna Medicare Rx® (PDP) coverage. It goes beyond the additional coverage provided by Original Medicare.

How it works:

You are required to select a primary care physician (PCP) and receive referrals for your care except in an emergency or urgent care situation. You pay a flat fee (copay) for most covered expenses. For some services, you pay a percentage of the expense (coinsurance).

What’s special:

Our rates include the cost for prescription drug coverage, so you get coverage for medical and Rx all from one plan. Be sure to contact the Sears Retiree Service Center to see if the rate in your area has changed.

  • You can change your PCP at any time, for any reason. In fact, you can change your PCP online at www.aetnanavigator.com.
  • There is no deductible.
  • Preventive care is covered at no additional cost.
  • You have medical coverage whenever you travel to another Aetna Medicare Plan service area with Aetna’s U.S. Travel Advantage Program; however, you must enroll by calling Aetna when you travel.
  • You’re always covered for emergency medical treatments when traveling outside the United States.
  • You have access to DocFind®, our online provider directory.

What you should know:

  • The Aetna Golden Medicare Plan (HMO), sometimes referred to as a Medicare Part C plan, provides Medicare Part A and Part B coverage. Keep in mind, all Aetna Medicare Plans (HMO) have Medicare Part D prescription drug coverage.
  • You need a referral from your PCP for most covered services under this plan. If you don’t get a referral, you may be responsible to cover the entire cost of care.

Learn more about the Aetna Golden MedicareSM Plan (HMO) plan benefits

2014 Aetna MedicareSM Plan (HMO) Adobe PDF document

2013 Aetna MedicareSM Plan (HMO) Adobe PDF document

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:

Wellness Programs

  • Aetna Silver & Fit program—available to all Aetna Golden Medicare Plan (HMO) members at no extra cost. We'll pay for your health club membership. Visit the Silver & Fit website to learn more and find fitness centers in your area.
  • Personal Health Record—keep track of essential health information in a single, secure location online; get tips on alternative therapies; track important health numbers like, blood pressure, weight and other health markers in easy-to-understand graphs and charts.
  • Dental program - dental discounts are included through the Vital Savings Aetna Discount Card. If you are an Aetna Medicare Advantage member, you automatically have access to the Vital Savings Discount Card. Call 1-888-BE-VITAL for more information. Or visit the Vital Savings website.
  • Simple Steps to a Healthier Life® - is an interactive online health and wellness program that can enhance your health and productivity. Simple Steps to a Healthier Life can provide:

    - Online health assessment
    - Tailored health reports
    - Personalized online wellness programs
    - Easy-to-find health information, resources and tools

    Want to learn more?
    - Go to www.aetna.com. Log in to your secure member website.
    - Then, select the Simple Steps to a Healthier Life link to get started.
    - Click on Assess Your Health with Simple Steps to a Healthier Life®
    - Complete new or update current health assessment.
  • Healthy Lifestyle Coaching—speak to a licensed professional by phone to develop a specific program based on your health needs; learn how to manage weight and/or stress, quit smoking and maintain good health.

Health and Wellness Discounts

    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.

      • 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.

      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.

Core Features

  • Care Management Program—if you are diagnosed with one or more chronic conditions, specially trained medical professionals will work with you and your health care provider to help evaluate, understand and manage your condition(s).
  • Cancer Screenings—receive reminders to have regular screenings for breast, colorectal and cervical cancers.
  • Case Management—get personalized support with chronic and/or serious health conditions by specially trained medical professionals.
  • Informed Health® Line1—speak with a registered nurse, 24/7, on health-related issues; access Aetna’s Audio Health Library to learn about various health conditions in English or Spanish.
  • National Medical Excellence Program® —from a medical emergency to a rare transplant procedure, a registered nurse manager or a case manager will help you manage through a difficult procedure or an unfamiliar health care system while traveling far from home.
  • Patient Safety through MedQuery® Care Considerations—identify potential errors and inconsistencies in care and communicate them to the treating physician, improving quality of care and preventing errors.
  • DocFind—If you have an Aetna Medicare Plan (PPO or HMO) or an Aetna Medicare Rx Plan (PDP), you have access to this online provider directory, making it easier to find physicians, hospitals, pharmacies and other participating health care professionals. 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.

1 While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs.

Aetna Medicare Rx® (PDP) coverage is included with the Aetna Golden Medicare Plan (HMO) for Sears Holdings retirees. That’s comprehensive coverage from one company.

  • Coverage for thousands of brand-name and generic prescription drugs
  • More than 65,000 participating pharmacies nationwide, including a mail-order program
  • Access to Aetna Rx Home Delivery® for mail order and Aetna Specialty Pharmacy® for hard-to fill medications
  • 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 medications delivered to your home or another location of your choice with no additional cost for standard shipping.

Aetna Specialty Pharmacy®
You 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 medications
  • 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 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 drugs with new generic 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 drugs to Part D enrollees who have reached the coverage gap and are not already receiving "Financial Assistance." It's possible that you may have a higher cost share when viewing your benefits in detail.

Note: There is a monthly plan premium for the Aetna Medicare Plan you select. This premium is in addition to your monthly Medicare Part B premium. Call the Sears Holdings Retiree Service Center to learn more about your premium costs.

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 1-800-254-2239
(TTY: 711) Monday through Friday, 8 a.m. to 6 p.m. ET

Ready to enroll?

Call the Sears Holdings Retiree Service Center at 1-800-762-7327
Monday through Friday, 7 a.m. to 7 p.m. CT

Retiree Health Plans Powered by Aetna

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18.00.904.1 (10/13) GRP_13_385

Page Last Updated: November 26, 2013