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Aetna® Medicare Member FAQs

Have questions about Medicare? There’s a good chance someone else has already asked them. From Medicare costs to care, you’ll find many of the answers you need in our frequently asked questions (FAQs).

Managing my Medicare costs

 

If you paid out of pocket for an eligible health service or product, you can send us a form to ask us to pay you back.

 

There are different forms for different services. Get the form you need, and learn how to submit it.
 

To request coverage for a medical service or prescription drug, you must follow a few steps. For example, the process to request a coverage decision for medical services can be different than the process for prescription drugs. You can learn more about coverage decisions by selecting this link.

 

Learn about Medicare coverage determinations
 

An appeal is a formal way of asking us to review and change a coverage decision we made. The appeals process can differ depending on what type of medical service you’re trying to appeal. You can learn more about how to appeal a Medicare coverage decision for medical coverage or prescription drugs at our appeals and grievances center.

 

Learn about appeals

The Medicare Extra Help program is for those with limited income and resources. It helps pay for Medicare Prescription drug costs if you qualify.

 

Learn more about Medicare Extra Help

Managing my Aetna Medicare plan

 

If you’re moving to a new address or getting a new phone number, please let us know right away. Just call Aetna Member Services at the number on your ID card. Based on where you move, you may need to enroll in a new plan.


If you get Aetna Medicare coverage through an employer, union or retiree plan, you may need to contact your benefits administrator to update your address or phone number.

If you need a new or additional ID card, you can view and print one within your secure member website. A digital or printed card is identical to a plastic ID card. If you’re unable to log in or do not have an account, please call the Aetna Member Services phone number to log in or replace a lost card.

 

Log in to replace your ID card

 

Call Aetna Member Services

There are two main time periods when you can change or leave your Medicare Advantage (Part C) or prescription drug (Part D) plan.

 

During Medicare's annual election period: 10/15 – 12/7

 

From October 15 through December 7 each year, you can decide to keep your current plan or select a new plan. Your coverage will begin on January 1 of the following year, if we get your request during the annual election period.

 

Medicare beneficiaries may also enroll in an Aetna Medicare plan through the CMS Medicare Online Enrollment Center located at Medicare.gov.

 

During a Medicare special enrollment period granted to you for certain situations

 

In certain situations, you can change your Medicare plan outside of Medicare’s annual election period. Some examples include if you:

 

  • Move out of your plan’s service area
  • Lose other creditable prescription drug coverage (prescription drug coverage that pays out, on average, at least as much as a Medicare Part D plan)
  • Live in a long-term care facility (like a nursing home)
  • Have Medicaid

 

If you get coverage from an employer or group health plan, review the information they provided to see what options are available to you.

 

Generally, your membership on your current plan will end on the last day of the month after we get your request to switch to Original Medicare or another plan.

We’re so sorry for your loss. And we're here to help and support you during this challenging time.
 

Have you already notified the Social Security Administration, or SSA, of your loved one’s death? If not, you should do so right away by calling 1-800-772-1213 (TTY: 1-800-325-0778). Connecting with the SSA is the only way to officially close your loved one's account. You may still receive premium bills from us until the account is closed.
 

If you have questions about their plan or premium, call us.
 

  • For Aetna Medicare Advantage and prescription drug plans call 1-844-826-5296 ${tty}. We're here 7 days a week, 8 AM to 8 PM.
  • For Aetna Medicare Supplement plans call at 1-800-264-4000 ${tty}. We're here ${medsupphours}.

Managing my care with Aetna Medicare

 

Aetna plans have a home delivery option through the CVS Caremark Mail Service Pharmacy. To get started with home delivery, please visit the CVS Caremark Mail Service Pharmacy page. Not all benefits and services are available in all plans.
 

If you qualify, you may complete the forms below to enroll.

 

Mail Service Order Form


Mail Service Order Form (Spanish)

 

Please mail CVS Caremark® Mail Service Pharmacy forms to:
 

CVS Caremark

PO BOX 659541

SAN ANTONIO, TX 78265-9541

If you need help just once, you can give us your permission by phone. We can speak with that person during the call.

If you want to appoint someone to act as a long-term care manager or authorized representative, you’ll need to mail us an Authorization for Release of Protected Health Information (PHI) form. It lets this person access your personal health information. They can also speak with us on your behalf about benefits, coverage, claims, bills and more.

 

Open and print the PHI form


Open and print the PHI form (Spanish)

 

Return the completed form to us at the address or fax number shown on the form.

 

It’s important to know:

 

The PHI form doesn’t override Medicare Power of Attorney documents. You don’t need to complete the PHI form if you have a Power of Attorney (POA).

 

The PHI form is only good for one year. You need to complete a new form each year for a representative to continue to assist you.

 

You need to complete a separate form (see below), if you need help filing an initial request for coverage, a grievance or an appeal.

 

Appointment of Representative CMS Form


Appointment of Representative CMS Form (Spanish)

If you are concerned about the quality of care that you received, you have a few options when filing a complaint. You can:

 

 

We’ll get back to you within 30 days (24 hours if you request a faster response). To file a complaint with Aetna Medicare, complete the Medicare Electronic Complaint form

You can select or change your PCP online through the secure member site Or you can call us at the number on your member ID card. You may need to choose your PCP from your plan’s network.

 

Log in to change your provider (PCP)

If you’re enrolled in a standard Aetna Medicare Plan (HMO)


If you get coverage from an out‐of‐network provider, your plan won’t cover their charges. Medicare and Aetna Medicare won’t be responsible either.

 

Generally, you must get your health care coverage from your primary care provider (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.

 

You’ll need to get a referral from your PCP for covered, nonemergency specialty or hospital care, except in an emergency and for certain direct access service. There are exceptions for certain direct access services.

 

You must use Aetna network providers, except for:
 

  • Emergency or urgent care situations
  • Out‐of‐area renal dialysis

If you get routine care from out‐of‐network providers, Medicare and Aetna Medicare won’t be responsible for the costs.

 

If you’re enrolled in Aetna Medicare Plan (PPO)

 

You have the flexibility to receive covered services from network providers or out‐of‐network providers. Out‐of‐network/non‐contracted providers are under no obligation to treat Aetna Medicare members, except in emergency situations. For a decision about whether we’ll cover an out‐of-network service, we encourage you or your provider to ask us for a pre‐service organization determination before you receive the service. Please call us or see your Evidence of Coverage (EOC) for more information, including the cost share for out‐of‐network services.

 

If you receive covered services from an out‐of-network provider, it’s important to confirm that they:
 

  • Accept your PPO plan
  • Are eligible to receive Medicare payment  

Aetna provides a directory for providers in Spanish.

 

For Spanish, you can search all directories here

Sometimes you need a referral or prior authorization before you can get care. A Medicare referral is a kind of preapproval from your primary care provider to see a specialist. A prior authorization or precertification is when your provider has to get approval from us before we cover an item or service. Medicare prior authorizations are often used for things like MRIs or CT scans. Your provider is in charge of sending us prior authorization requests for medical care.

 

View this list to find out what services and drugs require approval

 

Each plan has rules on whether a referral or prior authorization is needed. Check your plan’s Evidence of Coverage (EOC) to see if or how these rules apply.
 

Read more on the criteria Aetna uses to make decisions on your care
 

Tip: If you’re viewing an EOC online, you can simply press Ctrl + F to search for an item. You can find most rules for referrals or prior authorizations in Chapter 4 — Benefits Chart — of the EOC.

 
Medicare Part B covers DME when it’s medically necessary. First, talk to your doctor to get a prescription for your DME. Then, you’ll need to find an in-network DME provider.

Learn more about your DME benefit

Medicare Part B:

Some diabetic supplies and equipment are available through your Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan. Check your plan’s Evidence of Coverage (EOC) for details and limitations. Covered diabetic supplies and equipment may include:

 

  • Medicare covered durable insulin pump and most insulins used in the pump
  • Therapeutic shoes and inserts* for diabetics
  • Blood glucose monitors (BGMs) and testing supplies — exclusively OneTouch® by LifeScan
     

For 2024 plans
 

HMO plan members: Aetna Medicare plan members can order a BGM directly from LifeScan by calling 1-877-764-5390  ${tty} to order. Use order code 123AET200. Members can also get their BGM and testing supplies directly from a network pharmacy. Testing supplies include: lancing devices, test trips, lancets.


PPO plan members
: Aetna Medicare plan members can order a BGM directly from LifeScan by calling 1-877-764-5390  ${tty} to order. Use order code 123AET200. Members can also get their BGM and testing supplies directly from a participating pharmacy. Testing supplies include: lancing devices, test trips, lancets.
 

For 2025 plans
 

HMO plan members: Aetna Medicare plan members can get a BGM and testing supplies (lancing devices, lancets and test strips) directly from a network pharmacy.


PPO plan members
: Aetna Medicare plan members can get a BGM and testing supplies (lancing devices, lancets and test strips) directly from a participating pharmacy.

 

Continuous glucose monitors (CGM) and supplies

For a CGM to be covered, you must first get a prior authorization from your Aetna Medicare plan. CGMs and supplies (like sensors and transmitters) require a prescription from your physician. 

HMO plan members: You’ll need to get the CGM from a Medicare-certified DME provider, or from a network pharmacy for certain CGM models (like Dexcom or FreeStyle Libre). 

PPO plan members: You’ll need to get the CGM from a Medicare-certified DME provider, or from a participating pharmacy for certain CGM models (like Dexcom or FreeStyle Libre).

 

Download the DME National Provider Listing (PDF) to view potential suppliers.

 

Medicare Part D:

Diabetic supplies available under our individual Medicare Prescription Drug (PDP) and MAPD plans include:

 

  • Alcohol swabs and 2x2 gauze
  • Insulin needles, pens and syringes (when used for injecting insulin)

We want to make sure you can access your benefits even during urgent situations — like a public health emergency or state of disaster.

 

Finding care during a disaster or emergency

Aetna Medication Therapy Management (MTM) programs help you and your doctor manage your medications safely. Visit our MTM information page to learn more about these programs and see if you qualify.

 

More about Medication Therapy Management (MTM) programs

The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations. They issue these when coverage rules change for a service or drug.

 

View a list of coverage determinations

Aetna® and CVS Caremark® Mail Service Pharmacy are part of the CVS Health® family of companies.