Some items may require prior authorization from your medical benefit.
Managing my Medicare costs
If you paid out of pocket for an eligible health service or product, you can send us a form to ask us to pay you back.
There are different forms for different services. Get the form you need, and learn how to submit it.
To request coverage for a medical service or prescription drug, you must follow a few steps. For example, the process to request a coverage decision for medical services can be different than the process for prescription drugs. You can learn more about coverage decisions by selecting this link.
An appeal is a formal way of asking us to review and change a coverage decision we made. The appeals process can differ depending on what type of medical service you’re trying to appeal. You can learn more about how to appeal a Medicare coverage decision for medical coverage or prescription drugs at our appeals and grievances center.
The Medicare Extra Help program is for those with limited income and resources. It helps pay for Medicare prescription drug costs if you qualify.
Aetna® has teamed up with BeneLynk. Their advocates can help you navigate and apply for government programs that can save you money. This help comes with no added cost. BeneLynk wants to help you access more benefits. And make it easier to get care. Medicare members have saved thousands of dollars with their help.
BeneLynk may help you sign up for:
- Medicaid — This program helps cover medical costs for some people with limited resources. It may also include additional benefits such as vision, dental and transportation. You may be able to receive both Medicare and Medicaid benefits at the same time.
- Medicare Savings Programs — These programs help pay for Medicare costs. One benefit may be a rebate of your Part B premium. If you qualify, your state will help cover some or all of these costs.
- Medicare Extra Help — This federal program helps people with limited incomes lower the cost of some of their medicines.
BeneLynk may reach out to you by phone, text or by mail.
Want to learn more?
Call 1-888-715-0225 ${tty} Monday–Saturday, 8 AM–8 PM. Get answers to frequent questions — Explore BeneLynk’s FAQ
Managing my Aetna Medicare plan
If you’re moving to a new address or getting a new phone number, please let us know right away. Just call Aetna Member Services at the number on your ID card. Based on where you move, you may need to enroll in a new plan.
If you get Aetna Medicare coverage through an employer, union or retiree plan, you may need to contact your benefits administrator to update your address or phone number.
If you need a new or additional ID card, you can view and print one within your secure member website. A digital or printed card is identical to a plastic ID card. If you’re unable to log in or do not have an account, please call the Aetna Member Services phone number to log in or replace a lost card.
Log in to replace your ID card
There are two main time periods when you can change or leave your Medicare Advantage (Part C) or prescription drug (Part D) plan.
During Medicare's annual enrollment period: 10/15 – 12/7
From October 15 through December 7 each year, you can decide to keep your current plan or select a new plan. Your coverage will begin on January 1 of the following year, if we get your request during the annual election period.
Medicare beneficiaries may also enroll in an Aetna Medicare plan through the CMS Medicare Online Enrollment Center located at Medicare.gov.
During a Medicare special enrollment period granted to you for certain situations
In certain situations, you can change your Medicare plan outside of Medicare’s annual election period. Some examples include if you:
- Move out of your plan’s service area
- Lose other creditable prescription drug coverage (prescription drug coverage that pays out, on average, at least as much as a Medicare Part D plan)
- Live in a long-term care facility (like a nursing home)
- Have Medicaid
If you get coverage from an employer or group health plan, review the information they provided to see what options are available to you.
Generally, your membership on your current plan will end on the last day of the month after we get your request to switch to Original Medicare or another plan.
We’re so sorry for your loss. And we're here to help and support you during this challenging time.
Have you already notified the Social Security Administration, or SSA, of your loved one’s death? If not, you should do so right away by calling 1-800-772-1213 (TTY: 1-800-325-0778). Connecting with the SSA is the only way to officially close your loved one's account. You may still receive premium bills from us until the account is closed.
If you have questions about their plan or premium, call us.
- For Aetna Medicare Advantage and prescription drug plans call 1-844-826-5296 ${tty}. We're here 7 days a week, 8 AM to 8 PM.
- For Aetna Medicare Supplement plans call at 1-800-264-4000 ${tty}. We're here ${medsupphours}.
Managing my care with Aetna Medicare
Aetna plans have a mail order delivery option through the CVS Caremark Mail Service Pharmacy. To get started with mail order delivery, please visit the CVS Caremark Mail Service Pharmacy page. Not all benefits and services are available in all plans.
If you qualify, you may complete the forms below to enroll.
Mail Service Order Form (Spanish)
Please mail CVS Caremark® Mail Service Pharmacy forms to:
CVS Caremark
PO BOX 659541
SAN ANTONIO, TX 78265-9541
If you need help just once, you can give us your permission by phone. We can speak with that person during the call.
If you want to appoint someone to act as a long-term care manager or authorized representative, you’ll need to mail us an Authorization for Release of Protected Health Information (PHI) form. It lets this person access your personal health information. They can also speak with us on your behalf about benefits, coverage, claims, bills and more.
Open and print the PHI form (Spanish)
Open and print the PHI form (Chinese)
Return the completed form to us at the address or fax number shown on the form.
It’s important to know:
The PHI form doesn’t override Medicare Power of Attorney documents. You don’t need to complete the PHI form if you have a Power of Attorney (POA).
The PHI form is only good for one year. You need to complete a new form each year for a representative to continue to assist you.
You need to complete a separate form (see below), if you need help filing an initial request for coverage, a grievance or an appeal.
If you are concerned about the quality of care that you received, you have a few options when filing a complaint. You can:
- Call us at the number on your ID card
- Submit a complaint online
- Print a Medicare complaint form and fax or mail it to the address shown on the form
We’ll get back to you within 30 days (24 hours if you request a faster response). To file a complaint with Aetna Medicare, complete the Medicare Electronic Complaint form.
You can select or change your PCP online through the secure member site Or you can call us at the number on your member ID card. You may need to choose your PCP from your plan’s network.
If you’re enrolled in a standard Aetna Medicare Plan (HMO)
If you get coverage from an out‐of‐network provider, your plan won’t cover their charges. Medicare and Aetna Medicare won’t be responsible either.
Generally, you must get your health care coverage from your primary care provider (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.
You’ll need to get a referral from your PCP for covered, nonemergency specialty or hospital care, except in an emergency and for certain direct access service. There are exceptions for certain direct access services.
You must use Aetna network providers, except for:
- Emergency or urgent care situations
- Out‐of‐area renal dialysis
If you get routine care from out‐of‐network providers, Medicare and Aetna Medicare won’t be responsible for the costs.
If you’re enrolled in Aetna Medicare Plan (PPO)
You have the flexibility to receive covered services from network providers or out‐of‐network providers. Out‐of‐network/non‐contracted providers are under no obligation to treat Aetna Medicare members, except in emergency situations. For a decision about whether we’ll cover an out‐of-network service, we encourage you or your provider to ask us for a pre‐service organization determination before you receive the service. Please call us or see your Evidence of Coverage (EOC) for more information, including the cost share for out‐of‐network services.
If you receive covered services from an out‐of-network provider, it’s important to confirm that they:
- Accept your PPO plan
- Are eligible to receive Medicare payment
Aetna provides a directory for providers in Spanish.
Sometimes you need a referral or prior authorization before you can get care. A Medicare referral is a kind of preapproval from your primary care provider to see a specialist. A prior authorization or precertification is when your provider has to get approval from us before we cover an item or service. Medicare prior authorizations are often used for things like MRIs or CT scans. Your provider is in charge of sending us prior authorization requests for medical care.
View this list to find out what services and drugs require approval
Each plan has rules on whether a referral or prior authorization is needed. Check your plan’s Evidence of Coverage (EOC) to see if or how these rules apply.
Read more on the criteria Aetna uses to make decisions on your care
Tip: If you’re viewing an EOC online, you can simply press Ctrl + F to search for an item. You can find most rules for referrals or prior authorizations in Chapter 4 — Benefits Chart — of the EOC.
Medicare Part B covers DME when it’s medically necessary. First, talk to your doctor to get a prescription for your DME. Then, you’ll need to find an in-network DME provider.
Medicare Part B:
Some diabetic supplies and equipment are available through your Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan. Check your plan’s Evidence of Coverage (EOC) for details and limitations. Covered diabetic supplies and equipment may include:
- Medicare covered durable insulin pump and most insulins used in the pump
- Therapeutic shoes and inserts* for diabetics
- Blood glucose monitors (BGMs) and testing supplies — exclusively OneTouch® by LifeScan
For 2025 plans
HMO plan members: Aetna Medicare plan members can get a BGM and testing supplies (lancing devices, lancets and test strips) directly from a network pharmacy.
PPO plan members: Aetna Medicare plan members can get a BGM and testing supplies (lancing devices, lancets and test strips) directly from a participating pharmacy.
Continuous glucose monitors (CGM) and supplies
For a CGM to be covered, you must first get a prior authorization from your Aetna Medicare plan. CGMs and supplies (like sensors and transmitters) require a prescription from your physician.
HMO plan members: You’ll need to get the CGM from a Medicare-certified DME provider, or from a network pharmacy for certain CGM models (like Dexcom or FreeStyle Libre).
PPO plan members: You’ll need to get the CGM from a Medicare-certified DME provider, or from a participating pharmacy for certain CGM models (like Dexcom or FreeStyle Libre).
Download the DME National Provider Listing (PDF) to view potential suppliers.
Medicare Part D:
Diabetic supplies available under our individual Medicare Prescription Drug (PDP) and MAPD plans include:
- Alcohol swabs and 2x2 gauze
- Insulin needles, pens and syringes (when used for injecting insulin)
We want to make sure you can access your benefits even during urgent situations — like a public health emergency or state of disaster.
Aetna Medication Therapy Management (MTM) programs help you and your doctor manage your medications safely. Visit our MTM information page to learn more about these programs and see if you qualify.
The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations. They issue these when coverage rules change for a service or drug.
Aetna® and CVS Caremark® Mail Service Pharmacy are part of the CVS Health® family of companies.