Aetna® Medicare member FAQs

Did you pay out of pocket for a service or medicine your plan covers? You can ask us to pay you back. The form you need depends on the service.

Get the form you need and learn how to send it in.

You’ll need to follow a few steps. Coverage rules are different for medical services and drugs.

Learn about Medicare coverage determinations
 

An appeal means you ask us to look at our decision again.

What you need to do:

• Choose the right appeal form (each type of service has its own form).
• Fill it out and mail it to us.

Learn about appeals and how to file one

Medicare has a program called Extra Help for people with lower incomes. It can help you pay for your prescription drugs. Find out if you qualify.

Learn more about Medicare Extra Help

Aetna® has teamed up with BeneLynk. BeneLynk can help you apply for programs that can help save you money. The service is at no added cost to you, and members have saved thousands of dollars with their help.

BeneLynk may help you sign up for:

• Medicaid — This helps cover medical costs for some people with less resources. It may also include other 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 — This helps 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 helps people with less income 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 common questions with Explore BeneLynk’s FAQ

Your Aetna member ID card is an important part of your health plan. It shows that you have coverage. It also helps doctors and pharmacies confirm your benefits.

You should get your card in the mail within 7-10 days of the date your plan started.

Your card has:

• Your member ID number
• Important phone numbers
• Your primary care provider PCP name (if you have one)  

No, you can use your Aetna member ID card as soon as your coverage starts.

Check the Member Services page to find the phone number for your plan. You can also log in to your secure member website and print your card.

It’s important to bring your card to all doctor appointments and the pharmacy. It helps providers confirm your coverage and benefits.

Use your card to register for your secure member website, where you can:

• Find and print your Aetna member ID card
• Check and manage your claims
• Find discounts
• Look for doctors and specialists in your plan

Yes, some cards have a QR code. This makes it easy to get to your plan web page.

Log in to your secure member website. There, you can view or print a new ID card. A printed or online ID card works just like a plastic ID card.

• Log in to replace your ID card 

• Can’t log in or don’t have an account? Call Aetna Member Services

Did you move or get a new phone number? Let us know right away. Call the Aetna Member Services number on your ID card. You may need to switch plans if you’ve moved to a new area.

If you get Aetna Medicare coverage through:

• An employer
• A union
• A retiree plan

You may need to contact your benefits administrator to update your info.

Log in to your secure member website. There, you can view or print a new ID card. A printed or online ID card works just like a plastic ID card.

Log in to replace your ID card

Can’t log in or don’t have an account? Call Aetna Member Services

There are times you can change your Medicare plan. Here is when you can change or leave your Medicare Advantage (Part C) or prescription drug plan (Part D):

During Medicare's annual enrollment period: 10/15 – 12/7

• You can keep your plan or pick a new one each year during this time.
• Your new coverage starts January 1 of the new year.

Have Medicare? You can also enroll in an Aetna Medicare plan through Medicare’s Online Enrollment Center at Medicare.gov.

During special situations:

You can change your Medicare plan at other times if you:

• Move outside of your plan’s area
• Lose your drug coverage (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 your coverage is through an employer or group, ask them about your options.

Your old plan ends on the last day of the month when you pick a new plan.

We’re so sorry for your loss. We’re here to help you.
 

First, call the Social Security Administration at 1-800-772-1213 (TTY: 1-800-325-0778). 

• This will close your loved one’s account.
• You may still get bills until you do.

Then, call us:

• Have a Medicare Advantage or prescription drug plan? Call 1-844-826-5296 ${tty}. We're here 7 days a week, 8 AM to 8 PM.
• Have a Medicare Supplement plan? Call 1-800-264-4000 ${tty}. We're here ${medsupphours}.

Some Aetna® plans let you get your prescription drugs/medicines by mail Learn more about mail order delivery.
 

Please note: Not all benefits and services are available in all plans.

To enroll in mail order service, you can fill out one of these forms:

Mail Service Order Form

Mail Service Order Form (Spanish)

Then, mail the form to:
 

CVS Caremark

PO BOX 659541

SAN ANTONIO, TX 78265-9541

Need one-time help? You can call us and give us your OK over the phone.

Need long-term help? You can fill out a PHI form (Authorization for Release of Protected Health Information).

• This form lets someone else talk to us about your care.
• It lasts one year. You’ll need to fill out a new form each year to appoint them again.
• It does not replace a Medicare Power of Attorney (POA). If you have a POA, you don’t need the PHI.

Open and print the PHI form

Open and print the PHI form (Spanish)

Open and print the PHI form (Chinese)

Fill out the form then send it to us at the address or fax number on the form.

How can I let someone make requests for me?

You can give a caregiver or someone else permission to act on your behalf. They will be able to:

• File a complaint (grievance)
• Ask for coverage
• Make an appeal for you

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.

Appointment of Representative CMS Form

Appointment of Representative CMS Form (Spanish)

Concerned with the quality of care that you got? You have a few options. 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 (or 24 hours if you ask us for a faster response).

To file a complaint with Aetna Medicare online:

 Fill out the Medicare Electronic Complaint form. 

Here’s how you can do it:

• Log in to change your provider (PCP)
• Call the number on your member ID card.

Please note: You may need to choose your PCP from your plan’s network.

Do you have a standard Aetna Medicare HMO plan?

Seeing a provider who isn’t in network? Your plan won’t pay for their charges. Both Medicare and Aetna Medicare won’t pay for these costs either.

You need to get most of your care from your primary care provider/physician (PCP). They will give you a referral to see other providers and go to hospitals for certain services. For some services, your PCP needs to get approval (PA) from Aetna Medicare first.

You need a referral from your PCP for most specialty or hospital care, except in emergencies. There are also some services you can get without a referral.

You must use Aetna network providers, except for:

• Emergency or urgent care
• Out-of-area kidney dialysis

If you get routine care from providers who aren’t in the network, you’ll have to pay for it yourself.

Do you have an Aetna Medicare PPO plan?

You can get covered services from network providers or those who aren’t in the network. But providers who aren’t in the network don’t have to treat Aetna Medicare members, unless it’s an emergency.

Before you get a service from a provider who isn’t in the network, you can ask us if we’ll cover it. We call this a pre-service determination. You can call us or check your Evidence of Coverage (EOC) for more details, like how much you’ll pay for out-of-network care.

If you see a provider who isn’t in the network, make sure they:

• Accept your PPO plan
• Can get paid by Medicare

You can get a provider directory in Spanish.

Search for a plan directory in Spanish

Complete this form to have a copy mailed to you

Sometimes you need approval before you can get care. There are two types of approval:

Referral:

• This is when you need an approval from your (PCP) to see a specialist.

Prior authorization (approval in advance):

• This is when your doctor must get approval from Aetna before we cover a service or item.
• Your doctor will ask us for approval.

Each Aetna plan has rules about what needs approval. You can check your plan’s Evidence of Coverage (EOC) to see if or how these rules apply.

To check your plan’s rules:

• Look at your Evidence of Coverage (EOC)
• Check the list of services that need approval

Helpful tip:

• If you view your EOC online, press Ctrl + F to quickly search for your service.
• You can find these rules in Chapter 4 (Benefits Chart) of the EOC.

View list of services and drugs that need approval

Learn how Aetna decides coverage

Medicare Part B covers DME when it’s medically needed.

What you need to do:

First, talk to your doctor to get a prescription for your DME. They can send your prescription to a DME provider electronically or give it to you.

Then, you can use the provider search tool to find a DME provider. You may need to enter your ZIP code and choose your plan.

You can search by type of DME or search all providers. If you want your plan to help with the cost of your DME, make sure the provider is in your plan’s network.

If a preauthorization (PA) is required, your doctor will need to submit the PA request to Aetna.

Learn more about your DME benefit

Medicare Part B:

There are some diabetic supplies and equipment that are offered through your Part B plan. Part B plans are Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plans. Check your plan’s Evidence of Coverage (EOC) for more info.

We have plans that cover diabetic supplies and equipment like:

• Insulin pumps and most insulins used in the pump
• Therapeutic shoes and inserts* for diabetics
• For 2026, we exclusively cover Accu-Chek®/Roche and TRUE™/Trividia blood sugar meters and test strips.  

Blood glucose monitors (BGM) and supplies

For 2026 plans
 

HMO and PPO plan members: Aetna Medicare plan members can get certain BGM and testing supplies directly from a network pharmacy (like Accu-Chek/Roche or TRUE/Trividia). Get supplies like lancing devices, lancets and test strips.

Continuous glucose monitors (CGM) and supplies

For a CGM to be covered, you must have approval from your Aetna Medicare plan first (prior authorization).

Where to get your CGM:

• From a Medicare-certified DME provider
• Or a network pharmacy for certain CGM models (like Dexcom or FreeStyle Libre)

If you need a continuous glucose monitor (CGM) from a network pharmacy, you will need a history of insulin use in the last 6 months to make sure it’ll be covered. Prior authorization for monitors and sensors may apply as well as exception requests if exceeding quantity limits.

Download the DME National Provider Listing (PDF) to view potential suppliers.

Medicare Part D:

Your Medicare Part D coverage may be a stand-alone prescription drug plan (PDP) or a Medicare Advantage plan with drug benefits (MAPD). Part D plans will cover these diabetic supplies:

• Alcohol swabs and 2x2 gauze
• Insulin needles, pens and syringes (when used for injecting insulin)

What happens with my coverage during a disaster or public health emergency?

Yes, you can still use your benefits during emergencies.

We want to make sure you can always get care. Even in situations like a disaster or public health emergency.

Finding care during a disaster or emergency

MTM programs help you safely manage your medicines. These programs help you and your doctor make sure your medicines are working well.

Learn more about Medication Therapy Management (MTM) programs

Yes, Medicare sometimes changes what care or medicines they cover. These changes are called “National Coverage Determinations.”

Medicare tells you when these rules change for a service or a drug.

View a list of coverage determinations