Health Care Plans
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Medical Plans
Medical Plans
AEP offers four Medical Plans, which:
- Utilize the Anthem Blue Cross Blue Shield Network >
- Are available in all areas
- Include access to Care Coordinators provided by Quantum Health >
- Cover the same medical services and medications
- Fully cover in-network preventive care >
- Include Optum Rx Prescription Drug coverage >
All Plans provide coverage for the same medical services and medications, but have different:
- Deductibles
- Out-of-pocket maximums
- Coinsurance
Quantum Health Care Coordinator 1-877-324-3032 Monday through Friday 8:30 a.m. - 10:00 p.m. EST
Optum Rx 1-866-208-5184
Health Reimbursement Account (HRA) Plan
Enrollment in the HRA Plan for 2026 is limited to those currently enrolled in the Plan. Additionally, there will be no Plan design changes. The HRA Plan includes funds from AEP >
Compare the 2026 Medical Plan Details
2026 Monthly Medical Rates
Retiree and surviving spouse/dependent Medical Plan contribution rates are dependent upon various factors, including, but not limited to, termination date, and age and years of service at the time of termination.
If your preferred communication is mail, a personalized worksheet was mailed to your home address on October 17th which reflects the rates that are specific to you for 2026. You can also see your 2026 rates on aepbenefits.com, starting October 22nd, 2025. Once you log in, click Start Here and your updated contribution rates will be reflected as part of the 2026 enrollment process.
ID Cards
If you enroll in a new Medical Plan during Annual Enrollment, you will receive a new Medical Plan ID card in late December. Make sure to use your new card when you use the Medical Plan in the new year, including updating with your retail pharmacy.
Additional cards: Contact Quantum Health for a replacement ID card.
Call or visit Quantum Health at 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST.
Waiving Medical Coverage
If you are eligible for retiree medical coverage and have previously waived it or do not elect it this Annual Enrollment, you may still elect this coverage in the future—either during a future Annual Enrollment or within 31 days of a qualified change in family status.
Surviving spouses and dependents: Once you waive AEP Retiree Medical coverage, you lose your eligibility for this coverage permanently and will not be able to enroll at a later date.
What happens when you turn age 65?
Approximately two months prior to your 65th birthday, the AEP Benefits Center will send you information outlining eligibility and other details about benefits that will go into effect the first of the month in which you turn age 65, or the first of the month prior if your birth date falls on the first day of the month. The information will include the options and costs available to you under the Group Medicare Advantage Plans.
IMPORTANT: You must be enrolled in Medicare Parts A and B to be eligible to participate in AEP’s Group Medicare Advantage Plans upon turning age 65. If a covered dependent under the age of 65 becomes eligible for Medicare, for any reason, including disability, the Plan will assume they are enrolled in Medicare Parts A and B and will coordinate its payment of benefits accordingly.
You will also receive a letter from Optum Rx Medicare with information about the group-based, company-sponsored Medicare Part D Plan.
Please note that, when transitioning from an AEP Under-Age-65 Medical Plan to an AEP Medicare Advantage Plan, including any covered dependents, year-to-date accumulated deductibles and out-of-pocket maximum amounts do NOT transfer, due to rules governed by Medicare.
Health Care Advocacy
Think of Quantum's Health Coordinators as your personal team of nurses, benefit experts and claims specialists who will support your unique health care needs. They will be your one source to contact whenever you need help navigating your medical, wellness and pharmacy benefits.
To speak to a Quantum Health Care Coordinator, call 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST. You can even schedule time for a Care Coordinator to call you.
Visit the Quantum Health website to:
- View claims.
- Check deductible status.
- Download an ID card.
- Visit the Health Library.
- Make an appointment to talk to a Care Coordinator for a scheduled time.
Clinical Support with a Personal Touch
Quantum Health Nurse Care Coordinators are licensed clinicians providing dedicated, one-on-one support. A Nurse Care Coordinator is one nurse assigned to support entire families.
Nurse Care Coordinators go above and beyond to provide expert guidance on:
- AEP-provided benefit enhancements.
- Managing health conditions like diabetes, high blood pressure, high cholesterol, asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, kidney disease or high-risk pregnancy.
- Preparing for and recovering from inpatient hospital stays.
- Ensuring understanding of coverage and obtaining prior approval when needed.
- Collaborating with providers on care and healthcare needs.
- Solving claims issues and explaining medical bills.
- Understanding medical and prescription drug coverage.
To speak to a Quantum Nurse Care Coordinator, call 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST.
Understanding Prior Approvals
Some medical services require a prior approval before they are covered by a Medical Plan. Quantum Health Care Coordinators are happy to help patients and doctors through the process of obtaining the preauthorization.
The preauthorization process helps confirm whether a service will be covered before being billed. Care Coordinators will gather the necessary information from doctors to confirm Medical Plan coverage.
Services that require preauthorization include:
- Inpatient hospital admissions
- Surgery (inpatient or outpatient)
- Home healthcare and hospice care
- Skilled nursing facility admissions
- Transplants
- MRI, MRA and PET scans
- Durable medical equipment (DME)
- Oncology Care and services
- Outpatient surgeries
- Dialysis
- Partial hospitalization and intensive outpatient for mental health/substance abuse
- Genetic testing
- Specialty medications
Care Coordinators can answer any questions regarding preauthorizations or prior approvals at 1-877-324-3032, Monday through Friday, 8:30 a.m. - 10:00 p.m. EST.
Prescription Drugs
Prescription drug benefits are provided by Optum Rx and are integrated with your medical coverage.
Coverage details vary by plan:
HRA & HSA Plans
- Costs apply to both the deductible and out-of-pocket maximum.
- You pay the discounted cost of prescriptions until your deductible is met.
- After meeting the deductible, you pay coinsurance; AEP covers the rest.
- Once you reach the out-of-pocket maximum, prescriptions are covered at 100%.
- You can use HRA or HSA funds to help pay for prescriptions.
- Many preventive and maintenance medications are available at no cost. After three 30-day fills at a retail pharmacy, these must be filled as 90-day supplies at CVS or through Optum Mail.
PPO Plan
- Prescription costs do not apply to the deductible.
- You pay 20% coinsurance for prescriptions from the start.
- These costs count toward your out-of-pocket maximum.
- Many preventive and maintenance medications are available at no cost. After three 30-day fills at a retail pharmacy, these must be filled as 90-day supplies at CVS or through Optum Mail.
Visit optumrx.com
- Look up a drug to learn about the medication.
- Price a drug to see the cost of the medication and compare to a generic option.
- Search for a network pharmacy near you or when you are traveling.
No-Cost Drug List
Prescription Drug coverage includes many preventive and maintenance drugs at no cost. Medications are provided at no cost, but after three 30-day fills at a retail pharmacy, they must be filled for 90 days at a local CVS or through Optum Mail. Download the 2026 No Cost Drug List >
Optum Rx Price Edge Program—Save More on Medications!
Price Edge through Optum Rx is a cost-saving program that can help you find the best prices on generic non-specialty medications at in-network pharmacies. While your claim is being processed, Price Edge will actively search for discounts from other sources. If it finds a lower price for a covered medication, you’ll pay that reduced amount! Plus, any out-of-pocket expenses will count toward your deductible and out-of-pocket maximum.
Maintenance Medications
Medications can be filled at any in-network pharmacy. After three 30-day fills at a retail pharmacy, maintenance medications must be filled for 90 days through Optum Mail Order or a local CVS in order to continue to receive the in-network discounted price.
Specialty Medications
Specialty medications can only be filled through Optum Rx Specialty Pharmacy. Specialty medications often require an approved Prior Authorization before the medication can be filled. Specialty medication prescriptions are limited to 30 days.
ID Cards
The Medical Plan ID card is also the Prescription Drug ID card. The card is issued in the name of the AEP participant (subscriber). For additional ID cards, contact Quantum Health.
Call Optum Rx at 1-866-208-5184 or talk to a Quantum Health Care Coordinator at 1-877-324-3032 for questions about Prescription Drug coverage or how to find an in-network pharmacy.
Dental Plans
1-800-243-1809
Retirees: Once you waive AEP Dental coverage, you will lose your eligibility for this coverage permanently and will not be able to enroll at a later date. Note: Exception for individuals on or after November 12, 2015 where AEP sold an operation. Please refer to the Aetna Dental Summary Plan Descriptions for additional details.
Surviving spouses and dependents: Once you waive AEP Dental coverage, you will lose your eligibility for this coverage permanently and will not be able to enroll at a later date. Please refer to the Aetna Dental Summary Plan Descriptions for additional details.
Base Plan
The Base Plan provides coverage similar to the current PPO Plan, has lower participant contributions, but does not include orthodontia coverage.
Buy-Up Plan
The Buy-Up Plan provides expanded benefits, including orthodontia coverage for both adults and children with a higher lifetime maximum of $2,500.
Vision and Hearing Coverage
1-866-723-0513
Retirees: Even if you have previously waived AEP Vision coverage or do not elect it this Annual Enrollment, you may still elect this coverage in the future—either during a future Annual Enrollment or within 31 days of a qualified change in family status.
Surviving spouses and dependents: Once you waive AEP Vision coverage, you will lose your eligibility for this coverage permanently and will not be able to enroll at a later date.
AEP offers vision health coverage through EyeMed Vision Care, in conjunction with Fidelity Security Life. Coverage includes eye exams, contacts (including disposable contacts) and eyeglass lenses and frames. It also offers discounts on special features, such as scratch-resistant lenses, non-prescription sunglasses, laser eye surgery and more.
Participants who have Type 1 or Type 2 diabetes are eligible for a follow-up exam and additional testing twice per benefit year.
Create an account at eyemed.com to view their long list of special offers, track claims, find a provider and more.
EyeMed Secondary Purchase Plan
After your initial in-network benefits have been used, you are able to receive ongoing discounts on additional eyewear purchases for the remainder of the 12-month period (365 days).
Your ongoing secondary purchase discounts are:
- 20% discount on non-covered items, including non-prescription sunglasses;
- 40% discount on a complete pair of prescription eyeglasses; or
- 15% discount on conventional contact lenses (not available for disposable/soft contacts)
This guide is not intended to be a Plan document, Summary Plan Description, or required notice with respect to any of the Plans mentioned. AEP reserves the right to modify, amend, suspend, or terminate the Plans at any time. Refer to the applicable Plan document if you have any questions relating to a specific Plan or benefit.