Medicare
Information and Resources
Important: Medicare Compliance Program Requirements Due by December 31, 2020
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.
For dually contracted MA and DSNP providers, we’ve combined the DSNP MOC and FDR attestations so that you need to complete only one.
Need more information on the Medicare Compliance requirements?
FDR and DSNP MOC Training Information:
Medicare compliance FDR program guide
Complete your attestation(s):
Complete our Medicare Compliance FDR Attestation
for participation in one or more of the following plans:
MA, MAPD, PDP, MMP
Complete our Medicare Compliance FDR & DSNP MOC Combined Attestation for participation in our DSNP and any of the following plans: MA, MAPD, PDP, MMP
Have questions on completing the attestation? Email us at FDRAttestation@AETNA.com and we’ll send you quick tips email to assist you.
Medicare and Dual Special Needs Plans expansion information and resources
Individual Medicare:
2021 Individual Medicare Service Area Expansion Counties
Aetna Medicare Advantage Quick Reference Guide
Dual Eligible Special Needs Plans (D-SNP)
2021 D-SNP Service Area Expansion Information
2020 D-SNP Service Area Expansion Information
NJ FIDE-SNP Frequently Asked Questions
Group Medicare:
Aetna Medicare PPO Plans (Information for nonparticipating providers)
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 -749 attributed Aetna Medicare Advantage members and are not participating in another Aetna/Coventry value based contract or program.
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.
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
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 non-retail pharmacies, both independent and chain.
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.
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