Medicare plan(s)
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.
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.
Required for all providers/delegates treating SNPs members.
Annual Medicare compliance attestations
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MA only MA and MMP plans |
No required attestation. Must meet requirements in our Aetna FDR Medicare compliance guide (PDF). |
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MA and SNP plans |
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Delegated entities: MA only MMP Only MA and MMP |
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Delegated entities: MA and SNP |
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Supporting information on our Medicare compliance program requirements
Provider and delegate frequently asked questions (PDF)
OfficeLink Updates newsletters
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
Individual Medicare
Dual Eligible Special Needs Plans (D-SNP):
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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.
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
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.
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.
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.
Transition of coverage for Part D
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.
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
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.