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Medicare resources for providers

Find information about Aetna Medicare Advantage plans, compliance 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 includes 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 considered a Medicare Advantage plan. It’s a plan that provides coordinated Medicare and Medicaid benefits for dually eligible individuals.

 

Aetna Medicare Advantage quick reference guide (PDF)

Annual Medicare compliance program requirements

New and existing participating providers in our Medicare Advantage (MA) plans are required to meet the Centers for Medicare & Medicaid Services (CMS) compliance program requirements for first-tier, downstream and related entities (FDR) as outlined in the Aetna FDR Medicare compliance guide and/or SNP Model of Care/MOC (PDF) training.

Review compliance guide and training

Aetna FDR Medicare compliance guide (PDF)

Required for all Medicare providers/delegates, regardless of the type of plan.

SNP Model of Care/MOC (PDF)

Required for all providers/delegates treating SNPs members.

Annual Medicare compliance attestations

 

Medicare plan(s)

Annual attestation requirements

MA only

MA and MMP plans

No required attestation. Must meet requirements in our Aetna FDR Medicare compliance guide (PDF).

MA and SNP plans

Delegated entities:

MA only

MMP Only

MA and MMP

Delegated entities:

MA and SNP

Medicare plan(s)

MA only

MA and MMP plans

Annual attestation requirements

No required attestation. Must meet requirements in our Aetna FDR Medicare compliance guide (PDF).

Medicare plan(s)

MA and SNP plans

Annual attestation requirements

Medicare plan(s)

Delegated entities:

MA only

MMP Only

MA and MMP

Annual attestation requirements

Medicare plan(s)

Delegated entities:

MA and SNP

Annual attestation requirements

Supporting information on our Medicare compliance program requirements

 

Provider office manual (PDF)

 

Provider and delegate frequently asked questions (PDF)

 

FDR compliance newsletters

 

OfficeLink Updates newsletters

 

Offshore information (PDF)

 

Note: Annual notification about requirements will be sent to providers via Adobe Acrobat Sign email or postcard. Providers also continue to be notified via OfficeLink Updates™ newsletters throughout the year. You can access the training and attestation at the link(s) above. Our compliance department completes random audits to ensure compliance on an annual basis.

Medicare and Dual Special Needs Plans expansion information and resources

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'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 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. This will help ensure that patients get their prescriptions without disruption.

For non-participating Aetna Medicare PPO providers

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.

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.

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