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Medicare resources for providers
Let us help you navigate all things Medicare. Find helpful info about Aetna® Medicare Advantage plans, billing, Part D prescription plans, appeals and more.
Learn about Aetna Medicare Advantage plans
Skip the guesswork. This guide breaks down HMO, PPO and SNP options, including D-SNPs, C-SNPs and more.
Individual Medicare plans
Expanding our reach to better serve your patients
Aetna Individual Medicare plans are in more areas in 2025 to help your patients access the care they need, where they are. Check what counties we've added this year.
Group Medicare plans (PPO)
Not a part of our network yet? Use our guide to learn about Medicare PPO plans, how to file claims and join our network. You can also find a sample member ID card.
Aetna Medicare PPO guide for non-participating providers (PDF)
Ready to join our quality network of health care professionals? Join our network.
Dual Eligible Special Needs Plans (D-SNP)
D-SNPs are Medicare Advantage plans (also known as Part C) for people who qualify for both Medicare and Medicaid (Qualified Medicare Beneficiaries). These plans offer qualified extra benefits to help improve access to care and lower costs. Use our guide to find details on eligibility, benefits and coverage.
Qualified Medicare Beneficiary quick reference guide (PDF)
D-SNP benefits vary by state. Find info for your location.
Institutional Special Needs Plans (I-SNPs)
Aetna I-SNPs help support people who need long-term care in a skilled nursing facility, rehabilitation center or residential treatment facility. Check our FAQs to find details on benefits, coverage and claims.
Chronic Condition Special Needs Plans (C-SNP)
Aetna C-SNPs help patients with ongoing health conditions like diabetes or heart disease. Check our FAQs to learn about these plans and find helpful resources.
Help your patients stay eligible for C-SNP
Medicare members need to have a qualifying chronic condition to enroll in a C-SNP. Be sure to fill out and sign this form to confirm your patient’s condition within 30 days of their enroll date.
Get to know Aetna Extended Service Area (ESA) Plans
Get to know Aetna Extended Service Area (ESA) Plans
New to ESA plans or want to learn more? We’re here to help. In this video, you’ll learn what these plans cover, tips to check patient eligibility and how billing works. You’ll also find contact info if you need help along the way.
Background music: Light guitar instrumentals play in background during the entire video.
Narration: Aetna Extended Service Area plans and you.
On-screen text: Aetna Extended Service Area (ESA) Plans and You
Media description (scene 1): Medical appointment with two Medicare patients speaking to a health care provider.
Narration: Not sure what an Extended Service Area plan is? You’re not alone. They are also known as ESA plans and can sometimes be confusing to both providers and members. And you may have a patient in your practice who is a member of one of these unique and versatile Aetna Medicare Advantage PPO plans. Members not only have access to in-network providers, but they can receive services from out-of-network providers at no additional cost to them.
On-screen text: What is an Extended Service Area (ESA) plan?
- Access to both in-network and out of network providers
- No additional cost to your patients
Media description (scene 2): Health care provider writing a treatment plan.
Narration: This plan design provides our members access to any provider who accepts Medicare assignment and agrees to bill Aetna. Over 80 percent of Aetna Group members have an ESA plan.
On-screen text: Access to any provider who accepts Medicare assignment and agrees to bill Aetna
Media Description (scene 3): Nurse explaining therapy to a Medicare member during a home visit.
Narration: To verify your patient’s benefits and coverage, simply confirm on your eligibility portal such as Availity or by contacting Aetna's provider services team at 1-800-624-0756 ${tty}, Monday through Friday, 8AM to 5PM local time.
On-screen text: Verifying patient benefits and coverage
Review the patient's benefits on your eligibility portal such as Availity
Contact Aetna’s Provider Services team at 1-800-624-0756, Monday–Friday, 8 AM–5 PM local time
Media description (scene 4): Doctor working with documents.
Narration: We’re here to make things more seamless for our members and their providers. With ESA plans, there are no referrals or precertification required, however precertification is recommended to reduce the chance of denials.
On-screen text: No referrals required. Precertification is not required for most services but recommended.
Media description (scene 5): Office staff member reviews documents carefully.
Narration: Billing is also simplified. Start by collecting the member’s copayment for covered services during the visit. Make sure to include the patient’s paid amount when submitting a claim. You’ll only have to submit one bill to Aetna. Please note that balance billing patients is not permitted according to CMS guidelines.
On-screen text: Billing simplified.
- Collect member copayment.
- Include patient paid amount.
- Submit one bill to Aetna.
Media description (scene 6): A desk with a stethoscope and medication history record form. A doctor is working on a laptop computer in the background.
Narration: Reimbursement is easy, too. You’ll receive your payment within 6 to 8 weeks of submission. The Medicare fee schedule and Medicare limiting charges will apply. If you already participate with Aetna, the terms of your agreement apply. But, if you don't, no contract is required to see patients enrolled in an ESA plan. It’s just that simple!
On-screen text: Provider Reimbursement
- Payment within 6-8 weeks
- Medicare fee schedule and limiting charges apply
- No contract required
Media description (scene 7): Health care professional discusses medical information with a Medicare patient.
Narration: We’re here to help. For more information on billing and payment, visit the website on the screen or give us a call at 1-800-624-0756 ${tty}, Monday through Friday, 8AM to 5PM local time, to speak with our provider services team if you have questions.
On-screen text: For more information on billing and payment.
Visit aet.na/claims or call 1-800-624-0756 Monday–Friday, 8 AM–5 PM
Media description (scene 8): Doctor talks to a Medicare patient in a hospital.
Narration: Together we can improve the health of our community. Healthier happens together. Thanks for watching.
On-screen text: Healthier happens together®
Media description (scene 9): Doctor and patient smile and give each other a high five in front of a tablet.
Why join our Medicare Advantage Quality Incentive Program?Better care for patients, rewards for you
This program helps primary care providers improve patient outcomes through early detection and proactive management of chronic conditions. You focus on delivering quality care — we provide support and incentives.
You can join this program if:
- You’re a primary care physician with 50 to 749 attributed Aetna Medicare Advantage members. These are members who've been assigned to a provider who’s accountable for the quality and cost of their care.
- You’re not participating in another Aetna value-based contract or program
Get program details and learn how it works.
Part D prescription drug coverage
Check if we cover a drug and find brand-name alternatives.
Find utilization management requirements and forms.
Enrolling makes it easier for your patients to get their medicine
Do you prescribe medicine to patients with Part D plans? You need to enroll in the Part D program or opt out. This helps ensure your patients get their prescriptions when they need them.
Want to join our Part D pharmacy network?
We welcome pharmacies to the Aetna Medicare Part D pharmacy network. The network includes retail and non-retail pharmacies, both independent and chain.
Independent retail pharmacies
To join our Part D network, fill out our request form. Be sure to have your NCDDP number handy and fill in all fields.
Independent non-retail pharmacies
To join our Part D network, call CVS Health® at 480-391-4623.
Non-retail pharmacies include:
- Long-term care pharmacies (serves nursing homes and assisted living facilities)
- Home infusion pharmacies (provides IV medicine to patients at home)
- Mail-order pharmacies (delivers prescriptions to patients)
Chain pharmacies or pharmacy services administrative organizations
To join our Part D network, follow these steps:
Step 1: Gather this info
- Pharmacy name
- Chain code/NCPDP
- Name, address and phone number of the pharmacy contact person
- Name and title of the authorized agreement signer
Step 2: Send us your request — we’re happy to help.
Transition of coverage: Helping patients get their medicine when they need it
Your patient may take a Part D drug that isn’t on our preferred list or needs extra steps to be approved. In certain cases, they may be able to get a transition supply of their medicine to help stay on track with treatment. We can help you navigate the process.
More resources for you
Medicare coverage determinations
Medicare rules can change. Stay informed about patient coverage.
Medicare disputes and appeals
Learn about the appeal process and where to go if you need help.
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.