Find your plan information
If you get coverage from an employer or group health plan, review the information you received about your plan.
Choose your location and plan:
Other coverage information
Prescription drug coverage
See a list of covered drugs for your plan
Flu shot benefit
Medicare Coverage Determinations
The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations when a service’s or drug’s coverage rules change.
View a list of coverage determinations
Coverage during a disaster or emergency
We want to make sure you can access your benefits even during urgent situations. Like a public health emergency or state of disaster.
Seeking care during a disaster or emergency
How we review new technologies
Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device.
When we learn about a new technology, we:
- Carefully review the latest information and ask experts for their opinions.
- Compare the information with well-known standards.
- Base all of our decisions on making sure you have the right care and services.
Our utilization management program
We help our members get medically necessary health care services in the most cost-effective way under their health plan. By working with our members and physicians, we evaluate services for medical appropriateness, timeliness and cost.
- Base our decisions on appropriateness of care, service and plan coverage.
- Use nationally recognized guidelines and resources to make changes.
- Don’t pay or reward providers, employees or others for denying coverage or care.
- Focus on reviewing the risks of members who aren’t fully using certain services.
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Aetna Medicare’s pharmacy network offers limited access to pharmacies with preferred cost sharing in: Suburban NY; and Rural AR, NY, and UT. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at http://www.aetnamedicare.com/pharmacyhelp.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/coinsurance may change on January 1 of each year.