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    Medicare

    Information and resources for health care providers.

    Important: Annual Medicare Compliance Program Requirements



    Each year, all contracted providers participating in our Medicare Advantage (MA), Prescription Drug Plans (MAPD & PDP), Medicare-Medicaid (MMPs) and/or Dual Special Needs Plans (DSNPs) are required to attest to meeting the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream and related (FDR) entities and if contracted for DSNP, the MOC training.

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    Need more information on the Medicare Compliance requirements?

    FDR and DSNP MOC Training Information:

    Medicare compliance FDR program guide (PDF)

    FDR frequently asked questions (PDF)

    DSNP Model of Care (MOC) (PDF)

     

    Read our Office Manual and/or Newsletters to learn more on Medicare program requirements:

    Office Manual (PDF)

    FDR Compliance Newsletters

    OfficeLink Newsletters

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    2021 Medicare Compliance FDR or FDR/DSNP Attestations:

    The 2021 Medicare Compliance FDR Attestations will open in 2nd or 3rd quarter of 2021.  The attestation links will be posted on this site when released.

    Have questions on the Medicare Compliance or DSNP Programs? Email us at FDRAttestation@AETNA.com. 

    Medicare and Dual Special Needs Plans expansion information and resources

    INDIVIDUAL MEDICARE:

    GROUP MEDICARE:

    DUAL ELIGIBLE SPECIAL NEEDS PLANS (D-SNP):

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    Join our Medicare Advantage Quality Incentive Program

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    Join our Medicare Advantage Quality Incentive Program

    This program includes ways to promote early detection and assessment of chronic conditions. You'll provide the care your patients need, while earning incentives. You can participate if you are a primary care physician with 50 to 749 attributed Aetna Medicare Advantage members and are not participating in another Aetna/Coventry value-based contract or program.

    Part D prescriber enrollment requirement

    Part D prescriber enrollment requirement

    Any health care professional who prescribes drugs to patients with Part D plans must now enroll in the Medicare program or opt out. If you do not enroll or opt out, Medicare Part D may no longer cover these drugs as of February 1, 2017. Please try to enroll or opt out by November 1, 2016. This will allow time for application processing and ensure that patients get their prescriptions without disruption.

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    Medicare appeals information

    Find what you need to know about submitting a dispute or appealing a decision.
     

    Learn about the dispute process

    Medicare appeals for non-participating providers

    Appealing a Medicare hospital discharge

    Determining Medicare coverage

    The Centers for Medicare & Medicaid Services sometimes makes changes to coverage rules. See updated National Coverage Determinations (NCDs) that may affect patient coverage.
     

    See National Coverage Determinations


    See Aetna Part B Step Therapy criteria

    Supplemental retiree medical coverage

    The Aetna Supplemental Retiree Medical Plan is a fully insured, non-network-based commercial retiree group health product. In all states but Florida and Minnesota, it is offered as a supplementary medical plan, not a Medicare plan. In Florida and Minnesota, it is approved as a group Medicare Supplement product.


    This coverage is offered only to retirees and their eligible dependents who are enrolled in Medicare.


    Get claims processing information and other details about this plan (PDF)

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    For non-participating Aetna Medicare PPO providers

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    For non-participating Aetna Medicare PPO providers

    We are expecting an increase in membership for our Medicare Advantage preferred provider organizations. You are likely to see more patients with these health plans.

    Part D pharmacy participation

    We welcome pharmacies to the Aetna Medicare Part D pharmacy network. The network includes retail and non­retail pharmacies, both independent and chain.


    Learn how to participate in our Part D network

    Transition of coverage for Part D

    Members who are taking Part D drugs that are not on the plan's formulary, or that are subject to utilization management requirements, can get a transition supply of their drug under certain circumstances. They can work with you to complete a successful transition and avoid disruption in treatment.


    More about the Part D transition process (PDF)

    Prescription drug coverage

    Find formularies, prior authorization criteria and step-therapy criteria for our Medicare prescription drug plans.


    Find prescription drug information


    Find Part D prescription drug prior authorization and exception forms

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    Legal notices

    Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

    Health benefits and health insurance plans contain exclusions and limitations.