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Medicare Form

Download Documents: 2014

(Beneficiary use only)

Find the documents and forms you need for Aetna Medicare individual plans here.

Looking for documents such as enrollment and claim forms, as well as the Summary of Benefits for plans available near you? First, select the tab for the type of document you wish to view. The following documents are provided as Adobe PDF files:PDF Icon

Summary of Benefits

Offers detailed information about the plans available in your area, benefits, prescription drug coverage, and costs

Choose a state and a county from the lists below.

Multi-language insert
Advises we have free interpreter services to answer questions about our plans. The notification is available in over 15 languages.

Benefits at a Glance

An easy-to-understand chart, with an overview allowing you to compare plans

Choose a state and a county from the lists below.

Notice of Coverage Determinations

The Centers for Medicare and Medicaid Services (CMS) released new National Coverage Determinations that affect your coverage. Learn more by selecting a link below.

Get Adobe ReaderYou will need Adobe® Acrobat Reader to view some of the materials. You can download the latest Acrobat Reader software free by clicking this link. Download Adobe Reader.

LET’S TALK Call us at 1-888-247-1028
(TTY: 711). We are available from
8 a.m. - 8 p.m., local time, 7 days a week, from 10/1 - 2/14,
8 a.m. - 8 p.m., local time, Monday - Friday, from 2/15 - 9/30

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Click here for a list of Aetna Medicare plans that will not be renewing for 2015.

Aetna Medicare is an HMO/PPO/PDP plan with a Medicare contract. Enrollment in Aetna Medicare depends on contract renewal. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

Plans are offered by Aetna Health Inc., Aetna Health of California Inc., and/or Aetna Life Insurance Company (Aetna). Not all health services are covered. See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location.

You may enroll in the plan only during specific times of the year. Contact Aetna Medicare for more information.

You must have both Medicare Part A and Part B to enroll in a Medicare Advantage plan. You must have Medicare Part A and/or Part B to enroll in a Medicare prescription drug plan. You must continue to pay your Medicare Part B premium.

Alternate format materials are available by contacting Aetna Medicare at 1-888-247-1028 (TTY: 711), Monday through Sunday, 8 a.m. to 8 p.m.

This information is available for free in other languages. Please call our customer service number at 1-800-282-5366 (TTY: 711). Hours of operation: 7 days per week, 8 a.m. till 8 p.m. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-800-282-5366 (TTY: 711). Horario de atención: de 8 a.m. a 8 p.m., los 7 siete días de la semana.

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Choose the plan that's right for you.

Aetna Medicare

enroll now (MAPD)

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Aetna Individual
Plan (Medigap)

enroll now (Medigap)

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Aetna Medicare
Rx Plan

enroll now (PDP)

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