Check These New Year Health Plan Reminders
If you have a procedure in a facility that costs more than the limit, you’ll pay the difference—a strong encouragement to shop around.
As we start the new year, here are a few helpful reminders on changes that took effect in 2017:
Maintenance Choice
Maintenance choice for regular and daily prescriptions, such as those for high blood pressure or high cholesterol.
Buy these prescriptions in 90-day amounts from Aetna Home Delivery or a local CVS pharmacy. Your cost will be $20 for generic drugs, $70 for preferred brand names or $120-$250 for non-preferred brands. If you don’t follow this procedure, you’ll pay the full cost of the prescription with no plan coverage.
For questions, call Aetna at the number on your ID card. Check out pharmacy information at nafhealthplans.com and  the Maintenance Choice brochure.
Maximum Allowable Amounts
 Maximum allowable amounts are limits on how much the Exchange health plan will pay for procedures, such as:
- Carpal tunnel release
- Cataract removal
- Colonoscopy
- CT scan with, without contrast
- Inguinal herniorrhaphy (hernia surgery)
- MRI with, without contrast
- Tonsillectomy and adenoidectomy
- Upper endoscopy
Lab procedures like these are available in hospitals, stand-alone clinics, lab offices and other medical facilities. Your doctor may recommend a particular place, but you aren’t required to go there. Prices can range very widely, and are more expensive in a hospital and less expensive in other settings.
In most cases, the quality of service doesn’t vary. If you have a procedure in a facility that costs more than the limit, you’ll pay the difference—a strong encouragement to shop around.
The plan sets a coverage limit tailored to each ZIP code.
Check out Aetna’s maximum amount flyer. The overview is here.
