Medicare plan(s)
Medicare resources for providers
Find information about Aetna Medicare Advantage plans, compliance and attestation requirements, training, enrollment, appeals and more.
Aetna Medicare Advantage plans include any of the following:
Aetna Medicare Advantage (MA) plans include HMO, PPO and SNP (Special Needs Plans) benefits to Medicare-qualified members. Aetna offers Duals Special Needs Plans (D-SNPs) to members who also receive Medicaid benefits and/or assistance with Medicare premiums or Parts A & B cost-sharing and live in a county where Aetna Medicare offers a D-SNP. D-SNPs include any of the following:
- Dual Eligible Special Needs Plans (D-SNPs)
- Highly Integrated Dual Special Needs Plans (HIDE-SNPs)
- Fully Integrated Special Needs Plans (FIDE-SNPs)
The Aetna Medicare-Medicaid (MMP) is not a Medicare Advantage plan. The MMP is a plan that provides coordinated Medicare and Medicaid benefits for dually eligible individuals.
Medicare compliance training and attestation
Annual Medicare compliance program requirements
Every year, all providers who participate in our MA plans are required to meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream and related entities (FDR). You can find these requirements in the guide and training below.
Keep in mind: Our compliance team completes yearly random audits to ensure compliance.
Required compliance and training
Review Aetna FDR Medicare compliance guide (PDF)
Required for all Medicare providers/delegates, regardless of the type of plan.
Review SNP Model of Care/MOC training (PDF)
Required for all providers/delegates treating SNPs members.
Questions about compliance requirements? We’re here to help.
For more information and contact details, check out our frequently asked questions for providers and delegates (PDF).
Annual Medicare compliance attestations
Once you’ve reviewed required compliance and training, you can complete your yearly attestation, if required. This guide can help you with the next steps.
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Attestation requirements |
|---|---|
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MA only MA and MMP plans |
Attestation is not required. However, you must meet the requirements in our FDR compliance guide (PDF). |
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MA and SNP plans |
Attestation is required. Simply complete your training and attestation by December 31. Complete MA and D-SNP attestation (PDF). |
|
Delegated entities: MA only MMP Only MA and MMP |
Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA/MMP attestation for first-tier entities (PDF). |
|
Delegated entities: MA and SNP |
Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA and/or SNP attestation (PDF). |
Medicare plan(s) |
MA only MA and MMP plans |
|---|---|
Attestation requirements |
Attestation is not required. However, you must meet the requirements in our FDR compliance guide (PDF). |
Medicare plan(s) |
MA and SNP plans |
Attestation requirements |
Attestation is required. Simply complete your training and attestation by December 31. Complete MA and D-SNP attestation (PDF). |
Medicare plan(s) |
Delegated entities: MA only MMP Only MA and MMP |
Attestation requirements |
Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA/MMP attestation for first-tier entities (PDF). |
Medicare plan(s) |
Delegated entities: MA and SNP |
Attestation requirements |
Attestation is required for first-tier entities. Simply complete your training and attestation by December 31. Complete MA and/or SNP attestation (PDF). |
Supporting information on our Medicare compliance program requirements
You’ll receive notification about annual compliance requirements through Adobe Acrobat Sign email or postcard. You’ll also get updates in our OfficeLink Updates™ newsletters for updates throughout the year.
Browse OfficeLink Updates library
Additional resources
Medicare and Dual Special Needs Plans expansion resources
Individual Medicare
Dual Eligible Special Needs Plans (D-SNP):
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Institutional Special Needs Plans (I-SNP)
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. This will help ensure that patients get their prescriptions without disruption.
We welcome pharmacies to the Aetna Medicare Part D pharmacy network. The network includes retail and nonretail pharmacies, both independent and chain.
You may have patients who are taking Part D drugs that are not on the plan’s formulary or have utilization management requirements. These members can get a transition supply of their drug under certain circumstances. We can work with you to complete a successful transition and avoid disruption in treatment.
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
Join our Medicare Advantage Quality Incentive Program
Join our Medicare Advantage Quality Incentive Program
This program includes ways to promote early detection and assessment of chronic conditions. You provide the care your patients need, while earning incentives. You can participate in this program if:
- You are a primary care physician with 50 to 749 attributed Aetna Medicare Advantage members
- You are not participating in another Aetna value-based contract or program
Why join the Aetna Medicare PPO network?
Why join the Aetna Medicare PPO network?
More members are joining our Medicare Advantage Preferred Provider Organization plans. So you’re likely to see more patients with these health plans. You can find more information about these plans and how to join our network.
Additional resources
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
Determining Medicare coverage
The Centers for Medicare & Medicaid Services sometimes makes changes to coverage rules. These National Coverage Determinations (NCDs) may affect patient coverage.
Learn about National Coverage Determinations
Find Aetna Part B step therapy criteria
State of Connecticut retiree for special handling of Part B drugs
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.