Aetna Medicare forms to file a claim, appoint a representative and more
You can find help on this page to:
- File a claim — to request reimbursement (ask us to pay you back)
Appoint someone else to talk to us about your health care
Appoint someone to act on your behalf
Order prescription drugs from CVS Caremark® Mail Service Pharmacy
File an appeal or complaint, or ask for other coverage
Disenroll from a plan
Give someone permission to help with your care |
Choose form language (PDF) |
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Let someone talk to us about your health or coverage
You can always call us with a caregiver or someone else on the line to give them permission to speak with us. For each call, you would need to give permission again.
Would you like to give someone permission to speak with us more often? You can download this PHI (protected health information) form. Then, follow the steps in the form to fill it out and send it back to us. |
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Let someone make requests for you
You can give a caregiver or someone else permission to act on your behalf. They will be able to:
First, download and fill out this Appointment of Representative form. Then, have this person sign your form and send it to us. This person is then someone who can act on your behalf. They are known as your “appointed representative.”
This will last for one year from the date that you both sign the form. |
Give someone permission to help with your care |
Let someone talk to us about your health or coverage
You can always call us with a caregiver or someone else on the line to give them permission to speak with us. For each call, you would need to give permission again.
Would you like to give someone permission to speak with us more often? You can download this PHI (protected health information) form. Then, follow the steps in the form to fill it out and send it back to us. |
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Choose form language (PDF) |
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Give someone permission to help with your care |
Let someone make requests for you
You can give a caregiver or someone else permission to act on your behalf. They will be able to:
First, download and fill out this Appointment of Representative form. Then, have this person sign your form and send it to us. This person is then someone who can act on your behalf. They are known as your “appointed representative.”
This will last for one year from the date that you both sign the form. |
Choose form language (PDF) |
Order prescription (Rx) drugs by mail |
Choose PDF language |
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Order your Rx drugs from CVS Caremark Mail Service Pharmacy
Check to see if your Rx drugs are offered through mail order. If they are, you can use this form to place an order. First, download the form. Then, follow the steps in the form to fill it out and send it back to us.
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Order prescription (Rx) drugs by mail |
Order your Rx drugs from CVS Caremark Mail Service Pharmacy
Check to see if your Rx drugs are offered through mail order. If they are, you can use this form to place an order. First, download the form. Then, follow the steps in the form to fill it out and send it back to us.
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Choose PDF language |
File a Medicare appeal, complaint or coverage request |
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Do you have a concern about your coverage or care? Our Member Services team is here to help. You can call us at the number on your Aetna member ID card. |
File a Medicare appeal, complaint or coverage request |
Do you have a concern about your coverage or care? Our Member Services team is here to help. You can call us at the number on your Aetna member ID card. |
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Leave or cancel your plan (disenrollment) |
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Leave or cancel my Medicare Advantage (Part C) or Medicare Advantage Prescription Drug (Parts C and D) plan
Do you want to leave your current plan and not join another one? You can call us at the number on your ID card for help. Or find the Member Services number for your plan online. We’ll let you know your options. Like joining a plan, there are only certain times when you can disenroll.* You can download this form. Then, follow the steps in the form to fill it out and send it back to us.
How to send us your form
If there are more than 10 days before the end of the month: You should mail your form to:
Aetna
If there are 10 days or fewer left until the end of the month: You should fax your form to 1-866-756-5514.
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Leave or switch my prescription drug plan (PDP)
Do you want to leave or switch your Medicare Part D plan? Find out what your options are. |
Leave or cancel your plan (disenrollment) |
Leave or cancel my Medicare Advantage (Part C) or Medicare Advantage Prescription Drug (Parts C and D) plan
Do you want to leave your current plan and not join another one? You can call us at the number on your ID card for help. Or find the Member Services number for your plan online. We’ll let you know your options. Like joining a plan, there are only certain times when you can disenroll.* You can download this form. Then, follow the steps in the form to fill it out and send it back to us.
How to send us your form
If there are more than 10 days before the end of the month: You should mail your form to:
Aetna
If there are 10 days or fewer left until the end of the month: You should fax your form to 1-866-756-5514.
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Leave or cancel your plan (disenrollment) |
Leave or switch my prescription drug plan (PDP)
Do you want to leave or switch your Medicare Part D plan? Find out what your options are. |
For times you can disenroll
If you don't have creditable coverage for 63 days or more, you may have to pay a late enrollment penalty. For example, creditable coverage from an employer or union is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage. You can generally keep your coverage without paying a penalty if you decide to enroll in Medicare prescription drug coverage later.