Below are frequently asked questions about Medicare and Medicare coverage from Aetna Life Insurance Company. To view an answer to a question listed below, please click the question under the category you are interested in.

1. When did the Medicare prescription drug coverage begin?
2. Is it really necessary to have Medicare prescription coverage?
3. What does a Medicare prescription drug plan cover?

4. Can Aetna Medicare Rx^SM Plans help me save on the costs of medications?
5. How much will Medicare prescription drug coverage cost?
6. Does this program benefit someone who takes only a few prescription medications each month?
7. How do I pay plan premiums?
8. Which Aetna Medicare Rx^SM Plan allows me to pay the least out of my pocket to get a prescription filled?
9. What if I need help paying for prescription drugs?
10. Who qualifies for assistance? How can I find out more and apply for help?
11. Medicaid helped pay for my prescription drug coverage in the past. Do I have to join a Medicare prescription drug plan?
12. Will my Medicare Advantage plan premium go down if the government is helping pay for part of the Medicare prescription drug plan cost?

13. What is a “coverage gap?”
14. Do all Medicare prescription drug plans have a coverage gap?
15. What happens after the coverage gap?
16. What about a plan with continuous coverage - no coverage gap (or donut hole)?
17. Are both brand and generic prescription drugs covered?
18. How can I find out which prescription drugs are covered?
19. What is the Aetna Medicare Preferred Drug List, or formulary?
20. Can the Aetna Medicare Preferred Drug List change?
21. What if a medication I'm already taking is not included on the Aetna Medicare Preferred Drug List?
22. How do I request an exception to the Aetna Medicare Preferred Drug List?
23. What are generic medications?
24. Do Aetna Medicare Rx^SM plans cover wheelchairs and durable medical equipment (DME)?
25. Do the Aetna Medicare Rx^SM plans cover insulin and diabetic supplies?
26. What if I already receive prescription drug coverage as part of my employer's retiree benefits?
27. What is “creditable coverage?”
28. I have coverage through the Veteran's Administration (VA). Will my prescriptions continue to be covered?
29. What drugs are not covered under Medicare prescription drug plans?

30. Which pharmacies can I use to get covered prescriptions filled?
31. Can I get prescriptions by mail order?
32. How will a prescription mail-order service help me save money?
33. What if I'm traveling and need to fill a covered prescription?
34. Are prescriptions filled in Canada covered?

35. Do I need to sign up for Medicare prescription drug coverage?
36. Is it better to enroll in a plan that provides both medical and prescription coverage?
37. Who is eligible to join a Medicare prescription drug plan?
38. How do I enroll?
39. What if I didn't select a Medicare prescription drug plan by May 2006?
40. Is there a standard time period for people to change their coverage?
41. I just have Original Medicare (Parts A and B). Can I enroll in the Aetna Medicare Rx^SM Plan?
42. I have a Medicare Supplement (Medigap) plan. Can I enroll in a Medicare Rx plan?
43. Can a child or guardian enroll a parent in a prescription drug plan?
44. What happens to my Medicare card if I enroll in a prescription drug plan?
45. What happens to my Medicare card if I enroll in a Medicare Advantage Plan that has a prescription drug plan?

46. When will my Medicare prescription drug coverage begin if I enroll in an Aetna Medicare Rx Plan?
47. When should I expect to receive my Aetna Medicare member ID card?
48. What do I need to do to get my covered prescriptions filled if I have NOT received my new member ID card for the Aetna Medicare Rx Plan?

When did the Medicare prescription drug coverage begin?

The legislation passed by Congress and signed by President George W. Bush in 2003 created the Medicare Part D prescription drug benefit, giving everyone with Medicare access to prescription drug coverage effective January 1, 2006. Medicare beneficiaries may purchase prescription drug coverage from private insurance companies, such as Aetna. In addition, extra help is available for people with low incomes.

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Is it really necessary to have Medicare prescription coverage?

The costs for prescriptions go up each year. People often face even greater medical and prescription drug costs as they age. To get Medicare prescription drug coverage, you'll need to join a Medicare prescription drug plan, such as an Aetna Medicare Rx^SM plan.

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What does a Medicare prescription drug plan cover?

Medicare prescription drug plans cover preferred generic and brand-name drugs. Plans may have rules about what drugs are covered in different drug categories to be sure people with different medical conditions can get the treatment they need. Most plans will have a formulary, which is a list of drugs covered by the plan. This list must meet Medicare's requirements.

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COSTS

Can Aetna Medicare Rx^SM Plans help me save on the costs of medications?

Yes. Aetna negotiates discounts for medications with our participating network pharmacies. The plans include ways to help you save -- such as the prescription drug mail-order service and coverage for generic drugs.

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How much will Medicare prescription drug coverage cost?

It depends on the plan you select and where you live. Use the Aetna Medicare Solution Center to estimate the cost of an Aetna Medicare Rx Plan. Some people may qualify for financial help with prescription drug coverage, often referred to as "special help". This depends on factors the federal government has outlined.

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Does this program benefit someone who takes only a few prescription medications each month?

Yes. Even if you're healthy now and take only a few medications, your prescription drug costs could increase in the future from an unexpected illness. Also, if you are eligible for Medicare but do not participate in a Medicare prescription drug plan, you may have to pay a late enrollment penalty if you decide to join a plan later.

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How do I pay plan premiums?

You can pay the Medicare prescription drug plan premium directly to Aetna Medicare, have plan premiums deducted from your Social Security checks, or your employer can pay plan premiums for Medicare-eligible retirees.

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Which Aetna Medicare Rx^SM Plan allows me to pay the least out of my pocket to get a prescription filled?

Compare expected costs for Aetna Medicare Rx plans available where you live by using the Aetna Medicare Solution Center. We will ask you questions about your eligibility and coverage requirements, including what medications you take, to provide you with a comparison of the available Aetna Medicare Rx plans.

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What if I need help paying for prescription drugs?

Medicare helps those who qualify for extra help in paying for prescription drugs. The help depends on income and other resources.

To see if you qualify for getting extra help, call

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
• Your state Medicaid office.

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Who qualifies for assistance? How can I find out more and apply for help?

Eligibility for help is based on guidelines set by the federal government. You can apply for extra help through the Social Security Administration or a State Medical Assistance Office. Remember, the amount of help received depends on income and resources, and is determined by the federal government.

To see if you qualify for getting extra help, call

• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
• The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
• Your state Medicaid office.

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Medicaid helped pay for my prescription drug coverage in the past. Do I have to join a Medicare prescription drug plan?

Yes. After December 31, 2005, the Medicaid program stopped providing prescription coverage for people eligible for Medicare. (However, certain drugs that are not covered by Medicare may still be covered by your state Medicaid program.) Starting January 2006, Medicare began helping individuals cover their prescription drug costs. If you have full Medicaid benefits, including prescription coverage, you will be assigned to a Medicare prescription drug plan if you do not select one on your own, or choose to decline Medicare prescription drug coverage completely.

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Will my Medicare Advantage plan premium go down if the government is helping pay for part of the Medicare prescription drug plan cost?

If you have a Medicare Advantage plan without Medicare prescription drug coverage, the government financial help may not have an impact on your plan. If you have a Medicare Advantage plan with Medicare prescription drug coverage, the government financial help may affect your premiums, copayments or both.

If you know how much coverage you receive, check Aetna's Medicare Rx Plan subsidy table on the Low Income Subsidy page to see what your premium might be.

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COVERAGE

What is a “coverage gap?”

Also known as the "donut hole," it is a phase in the benefit design of a Medicare prescription drug plan. This phase occurs when a member has reached the initial coverage limit and ends once the member has reached the true out-of-pocket threshold. A member may be responsible for 100% of medication costs during this portion of the plan, although some plans may include full or partial coverage during this phase.

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Do all Medicare prescription drug plans have a coverage gap?

No. Some plans offer broader coverage and have continuous protection, even in the coverage gap period. The Aetna Medicare Rx Premier Plan provides coverage for generic drugs through this period. If you would like to protect yourself against out-of-pocket expenses — and you do not want to pay the full price for prescriptions as part of your plan — you may want to choose a plan with extended coverage.

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What happens after the coverage gap?

After you pay a specified amount of true out-of-pocket expenses (for 2008 the amount is $4,050) for your covered medications, most of your costs for prescriptions included in the Aetna Medicare Rx Plans will be covered, subject to modest cost sharing. For 2008 the cost sharing will be $2.25 for covered generics and $5.60 for covered brands or 5%, whichever is greater.

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What about a plan with continuous coverage - no coverage gap (or donut hole)?

We have a plan with coverage in the coverage gap. Take a look at the Aetna Medicare Rx Premier Plan, which covers generic drugs during the coverage gap phase.

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Are both brand and generic prescription drugs covered?

Yes. Aetna Medicare Rx^SM Plans cover both brand-name and generic prescription drugs. Refer to the Covered Drugs section of our website for more information.

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How can I find out which prescription drugs are covered?

Refer to the Covered Drugs section of our website for more information or visit the Aetna Medicare Solution Center.

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What is the Aetna Medicare Preferred Drug List, or formulary?

The Aetna Medicare Preferred Drug List (also known as a formulary) is a list of medications chosen by Aetna, in consultation with a team of health care professionals, including geriatric specialists. Drugs that appear on the Aetna Medicare Preferred Drug List have been chosen on the basis of sound medical data, safety and cost. Additionally:

• The Aetna Medicare Preferred Drug list has been approved by the Centers for Medicare and Medicaid Services (CMS), the Federal Agency that oversees the Medicare Program.
• The medications on the Aetna Medicare Preferred Drug List have been approved by the Food and Drug Administration (FDA) as safe and effective.
• Both brand-name and generic medications are on the Aetna Medicare Preferred Drug List.

For a complete list of all prescription medications covered by Aetna Medicare prescription drug plans, please call the Member Services number listed on your Aetna Medicare member ID card between 8:00 a.m. and 8:00 p.m., 7 days a week. TTY/TDD users for hearing or speech impaired should call: 1-800-628-3323. You can also refer to the Medicare Rx > Covered Drugs section of the website.

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Can the Aetna Medicare Preferred Drug List change?

The Aetna Medicare Preferred Drug List is updated from time to time and may change during the year. We will let affected members know at least 60 days before a medication is removed from coverage, moved to a higher cost-sharing level, or if precertification, quantity limit or step-therapy restrictions have been placed on a medication.

• From time to time, Aetna reviews the Aetna Medicare Preferred Drug List to make sure it meets the criteria for safety, effectiveness and overall value. Medications may be covered at a higher copayment and/or removed from the Preferred Drug List with advance notice of the change.
• As brand-name medications lose their patents and generic versions become available, the brand-name medication may be covered at a higher copayment.
• The Aetna Medicare Preferred Drug List may also change if a medication is taken off the market or becomes available without a prescription.
• If the Food and Drug Administration judges a drug on the Aetna Medicare Preferred Drug List to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove it from the Aetna Medicare Preferred Drug List.

For updated information about the medications covered by your plan, please go to Aetna Medicare Rx > Covered Drugs or call the Member Services number listed on your Aetna Medicare Member ID card. TTY/TDD users for hearing or speech impaired should call: 1-800-628-3323.

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What if a medication I'm already taking is not included on the Aetna Medicare Preferred Drug List?

You can find details regarding the transition process and exceptions for medications not covered under the plan in the Aetna Medicare Rx Covered Drugs section of the website.

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How do I request an exception to the Aetna Medicare Preferred Drug List?

You can ask Aetna to make a medical exception to our coverage rules. There are several types of exceptions that you can ask us to make:

• If you are enrolled in a Medicare closed formulary plan, you can ask us to cover your medication even if it is not designated as covered on the Aetna Medicare Preferred Drug List.
• You can ask us to waive coverage restrictions or limits on your medication. For example, for certain medications Aetna limits the amount of the medication that we will cover. If your medication has a quantity limit, you can ask us to waive the limit and cover a higher quantity.
• If you are enrolled in a Medicare open formulary plan, you can ask us to provide a more favorable level of coverage for nonpreferred medications. If your brand-name medication is usually considered a nonpreferred medication, you can ask us to cover it as a preferred medication instead. This would lower the amount you must pay for your medication.

When you are requesting an exception, you should submit a statement from your doctor supporting your request. Most decisions will be made within 72 hours of your request. Refer to the Aetna Medicare Rx Exceptions, Appeals and Grievances section for more information.

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What are generic medications?

• A generic medication has the same active-ingredient formula as the brand-name medication.
• Generic medications usually cost less than brand-name medications and are approved by the Food and Drug Administration (FDA).
• On the Aetna Medicare Preferred Drug List, generic medications are listed in lower-case italicized letters (for example: ranitidine), and brand-name medications are listed in all capitalized letters (for example: ZANTAC).

For updated information about the medications covered by your plan, please go to Aetna Medicare Rx > Covered Drugs or call the Member Services number listed on your Aetna Medicare Member ID card. TTY/TDD users for hearing or speech impaired should call: 1-800-628-3323.

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Do Aetna Medicare Rx^SM Plans cover wheelchairs and durable medical equipment (DME)?

These items are not included in the Medicare prescription drug coverage. They may be covered under Medicare Part A and/or B.

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Do the Aetna Medicare Rx^SM Plans cover insulin and diabetic supplies?

Yes. Insulin and some diabetic supplies are covered. Testing supplies such as lancets and test strips are covered under Medicare Part B.

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What if I already receive prescription drug coverage as part of my employer's retiree benefits?

It's up to you to decide what works best for you. If an employer or union offers prescription drug benefits, you should compare the plan and costs with those offered under the Aetna Medicare prescription drug plans. It is an employer's responsibility to inform their Medicare eligible retirees/employees if the prescription drug plan offered is on average, at least as good as the standard Medicare Part D benefit — that is, if it is creditable coverage.

Note: If your retiree plan is not considered "creditable coverage" and you choose not to purchase a Medicare prescription drug plan, you may have to pay more each month (penalty) if you want to join a Medicare prescription plan later.

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What is “creditable coverage?”

This is coverage that is, on average, at least as good as the standard Medicare prescription drug coverage the government has outlined. This is important if you decide not to select a Medicare prescription drug plan during your initial enrollment period — because you can join a Medicare Part D plan after the initial enrollment period without a penalty if you have coverage that is at least as good as basic Medicare prescription drug coverage.

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I have coverage through the Veteran's Administration (VA). Will my prescriptions continue to be covered?

VA benefits will not be affected. Medicare beneficiaries who currently have prescription drug benefits through the VA will be able to continue to obtain their prescriptions through the VA coverage.

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What drugs are not covered under Medicare prescription drug plans?

1. Drugs used for weight loss, gain or anorexia
2. Drugs used to promote fertility
3. Drugs used for cosmetic purposes or hair growth
4. Drugs used for SYMPTOMATIC relief of cough and colds
5. Prescription vitamins and minerals, EXCEPT prenatal vitamins and fluoride
6. Nonprescription drugs (OTC)
7. Outpatient drugs for which the manufacturer requires that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee as a condition of sale
8. Barbiturates (such as phenobarbital)
9. Benzodiazepines (such as Valium, Xanax, Restoril)
10. Erectile dysfunction drugs

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FILLING PRESCRIPTIONS

Which pharmacies can I use to get covered prescriptions filled?

More than 56,000 retail pharmacies participate in the Aetna Medicare Rx^SM Plan network. This includes pharmacies like CVS, H-E-B and Rite Aid. Find pharmacies using DocFind by entering your location, making a selection under "Pharmacies," then choosing "Aetna Medicare Rx" and Search Criteria.

Or use the Aetna Medicare Solution Center, choose a plan year under Compare Plans, select "Pharmacy Finder" from the left under Helpful Tools, and follow the directions to find a pharmacy near you.

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Can I get prescriptions by mail order?

Yes. If you take medications on an ongoing basis, this is a great way to save money. Covered prescription drugs are delivered right to your front door. If you depend on prescription medications to treat chronic conditions and diseases — such as arthritis, diabetes, heart conditions, asthma, high blood pressure and high cholesterol — you can order covered medications through the easy-to-use, convenient Aetna Rx Home Delivery^® service, Aetna's preferred mail-order service.

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How will a prescription mail-order service help me save money?

Aetna Rx Home Delivery is our preferred mail-order service designed to help you manage your health while watching your budget. Ordering medications to help with problems like arthritis, diabetes, heart conditions, asthma, high blood pressure, and high cholesterol is easy and convenient. Among its advantages are:

• Cost savings. Depending on the plan and the medication you use, you may be able to get a three-month supply of covered medications for the price that is typically paid for a two-month supply at a retail pharmacy. Standard shipping is always free.
• Simplicity. Aetna's easy, two-step process makes ordering maintenance medications a snap.
• Quality Service. Registered pharmacists check your orders for accuracy and are available 24 hours a day, 7 days a week, in case of emergencies.

      Also, the Aetna Pharmacy website can help you stay informed about your prescription drugs and learn how to use your prescription drug benefits wisely. You can get information about hundreds of prescription drugs, possible side effects, generic substitutions, and more.

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What if I'm traveling and need to fill a covered prescription?

You can fill a prescription at any of the pharmacies participating in the Aetna Medicare network, no matter where they are in the United States. Also, you can use the Aetna Rx Home Delivery^® prescription mail-order service.

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Are prescriptions filled in Canada covered?

Only drugs sold within the United States may be covered under the Medicare prescription drug plan.

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ENROLLING

Do I need to sign up for Medicare prescription drug coverage?

The Medicare prescription drug program is completely voluntary. If you want Medicare prescription drug coverage, you can choose to enroll in a plan that meets your needs. If you have Medicare, you can either enroll in a Medicare prescription drug plan (PDP) or in a Medicare Advantage plan with Medicare prescription drug coverage (MA-PD). Aetna has prescription drug plans throughout the country and Medicare Advantage plans in some areas.

Also, if you have Medicare, you can continue to receive prescription coverage through a group plan — one that an employer/former employer/union offers. You will need to contact the group's benefits administrator to find out more about the coverage.

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Is it better to enroll in a plan that provides both medical and prescription coverage?

It's up to you. Aetna Medicare has a full range of products for retirees. Medicare prescription drug coverage can be included in a Medicare Advantage plan (an HMO, a PPO or a PFFS). A Medicare prescription drug plan can also be combined with a Medicare Supplement plan. Aetna Medicare can provide information to you that can help you choose a plan that works for your individual needs. Learn more by visiting our Medicare Advantage Choices section of the site.

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Who is eligible to join a Medicare prescription drug plan?

Anyone eligible for Medicare Part A and/or B can join a Medicare prescription drug plan such as one of the plans Aetna Medicare offers. Anyone who is eligible will be accepted, regardless of current health condition. You must also live in the service area of the plan you are choosing in order to be enrolled.

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How do I enroll?

Enrolling is easy! Follow these simple steps:

1. Enroll online: Use our safe and secure Aetna Medicare Solution Center.
2. Enroll by phone: Call us at 1-800-529-5586 (TTY/TDD 1-800-628-3323), Monday - Friday, 8:00 a.m. - 6:00 p.m.
3. Enroll by mail: Complete and sign your enrollment form, then mail it to:
   
   Aetna Medicare Rx Plans
   P.O. Box 963
   Blue Bell, PA 19422-9921

      If you need help, call 1-800-529-5586 (TTY/TDD 1-800-628-3323), Monday - Friday, 8:00 a.m. - 6:00 p.m. We'll be happy to help you.

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What if I didn't select a Medicare prescription drug plan by May 2006?

There could be a penalty if you did not join during the initial enrollment period, which was November 15, 2005, to May 15, 2006. The penalty is 1% for every month you did not enroll, but were eligible. The exception is if you have creditable coverage, meaning you have a plan that is on average at least as good as the standard Medicare Part D coverage.

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Is there a standard time period for people to change their coverage?

Yes, the federal government has established periods when a person can join and change their Medicare prescription drug coverage. Refer to the website section Aetna Medicare Rx: Enrollment for more information.

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I just have Original Medicare (Parts A and B). Can I enroll in the Aetna Medicare Rx^SM Plan?

Yes, if it is during a valid enrollment period. Refer to the website section Aetna Medicare Rx: Enrollment for more information.

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I have a Medicare Supplement (Medigap) plan. Can I enroll in a Medicare Rx plan?

Yes. If your Medicare Supplement plan has drug coverage and you enroll in a Medicare prescription drug plan, you must contact your Medicare Supplement issuer to let them know you have joined a Medicare prescription drug plan. Your prescription coverage will be removed from your Medicare Supplement policy if you enroll in a Medicare prescription drug plan.

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Can a child or guardian enroll a parent in a prescription drug plan?

Generally, only a Medicare beneficiary can enroll. However, another individual (such as a court-appointed guardian) could be the legal representative or appropriate party to complete an enrollment or disenrollment request. Please refer to the "Appointment of Representation" section of Aetna Medicare Rx Exceptions, Appeals, and Grievances.

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What happens to my Medicare card if I enroll in a prescription drug plan?

Keep it. The prescription drug plan card will not replace your Medicare card. An Aetna Medicare Rx Plan card will be sent to individuals who join Aetna and be used when purchasing prescription drugs.

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What happens to my Medicare card if I enroll in a Medicare Advantage plan that has a prescription drug plan?

Keep it, but only use it for discounts and general identification purposes. You must use your Aetna Medicare member ID card when you require medical services or to obtain covered prescription drugs.

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MEMBER ID CARDS

When will my Medicare prescription drug coverage begin if I enroll in an Aetna Medicare Rx Plan?

Your Aetna Medicare Rx Plan coverage begins on January 1 if you enroll in a plan between November 15 and December 31. If you enroll during your initial enrollment period, your coverage begins the first day of the month after the month you enroll and become eligible for Medicare. For example, if you enroll in Aetna Medicare on January 23 and you are already Medicare eligible, your Medicare plan will begin on February 1.

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When should I expect to receive my Aetna Medicare member ID card?

Our goal is to send you an Aetna Medicare member ID card as soon as possible. Please contact Aetna Medicare Member Services if you have questions.

For	Call
Aetna Medicare Rx Plans (individuals)	1-877-238-6211
Aetna Golden Medicare, Aetna Golden Choice, and Aetna Medicare Open Plans (individuals)	1-800-282-5366
Aetna Medicare Rx Plans (members of group plans)	1-877-238-6211
Aetna Golden Medicare, Aetna Golden Choice, and Aetna Medicare Open Plans (members of group plans)	1-800-282-5366
Aetna Medicare Plans (Aetna retirees)	1-800-282-5366

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What do I need to do to get my covered prescriptions filled if I have NOT received my new member ID card for the Aetna Medicare Rx Plan?

Aetna Medicare members can get covered prescriptions filled at participating pharmacies if they have not received an Aetna Medicare member ID Card. To get your covered medications, you can:

1. Ask your pharmacist to call Aetna. If you're eligible for prescription drug coverage and Aetna has processed your application in our system and submitted it to CMS, we will make an exception and allow the covered prescription to process.
   
   
2. Print a temporary Aetna Medicare member ID card from Aetna Navigator™, the member part of our website. If a member has been processed in our system, he/she can print a temporary Aetna Medicare member ID card online through Aetna Navigator.
   
   
3. Submit a claim for prescriptions that you have filled at a participating pharmacy. If your application has not been processed, you can pay for your covered medications and submit a claim to Aetna once your enrollment is complete. NOTE: This is a temporary process. Get a claims form here.