Medicare
Information and Resources
Important: Medicare Compliance FDR Attestation
All contracted providers participating in Medicare Advantage (MA), Prescription Drug Plans (MAPD & PDP), Medicare-Medicaid Plans (MMP) and Dual Eligible Special Need (DSNP) are required to review and attest to meeting all Medicare Compliance requirements as outlined in the FDR program guide and office manual by December 31st of each year. If you do not complete the attestation each year, your participation status could be affected.
Complete your 2019 Attestation at the link below:
Need more information on the Medicare FDR program?
See our Medicare compliance FDR program guide
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