Aetna Medicare Rx Plans (PDP) FAQ

Frequently Asked Questions 

• About Medicare 
• About Aetna Medicare Advantage Plans 
• About Aetna Medicare Plans 

About Aetna Medicare Rx^® Plans (PDP) 

Below are frequently asked questions about Medicare and Aetna Medicare Rx^® Plans (PDP). To view an answer, simply click on that question. The questions are listed in eight categories:

• General
• Costs
• Coverage
• Filling Prescriptions
• Enrolling
• Member Effective Date
• Member ID Cards 
• CVS/pharmacy Preferred Network 

General

1. When did the Medicare prescription drug coverage begin?
2. Is it really necessary to have Medicare prescription coverage?
3. What does a Medicare prescription drug plan cover?
4. Does Aetna have a quality improvement program?

Costs

1. Can Aetna Medicare Rx^® Plans (PDP) help me save on the costs of medications?
2. How much will Medicare prescription drug coverage cost?
3. Does this program benefit someone who takes only a few prescription medications each month?
4. How do I pay plan premiums?
5. Which Aetna Medicare Rx^® Plan (PDP) allows me to pay the least out of my pocket to get a prescription filled?
6. What do I do if I need help paying for prescription drugs?
7. Who qualifies for help? How can I find out more and apply for help?
8. Medicaid helped pay for my prescription drug coverage in the past. Do I have to join a Medicare prescription drug plan?
9. Will my Medicare Advantage plan premium go down if the government is helping pay for part of the Medicare prescription drug plan cost?

Coverage

1. What is a “coverage gap?”
2. Do all Medicare prescription drug plans have a coverage gap?
3. What happens after the coverage gap?
4. Are both brand and generic prescription drugs covered?
5. How can I find out which prescription drugs are covered?
6. What is the Aetna Medicare Preferred Drug List, or formulary?
7. Can the Aetna Medicare Preferred Drug List change?
8. What if a medication I'm already taking is not included on the Aetna Medicare Preferred Drug List?  
9. How do I request an exception to the Aetna Medicare Preferred Drug List?
10. What are generic medications?
11. Do Aetna Medicare Rx^® Plans (PDP) cover wheelchairs and durable medical equipment (DME)?
12. Do the Aetna Medicare Rx^® Plans (PDP) cover insulin and diabetic supplies?
13. What if I already receive prescription drug coverage as part of my employer's retiree benefits?
14. What is “creditable coverage?”
15. I have coverage through the Veteran’s Administration (VA). Will my prescriptions continue to be covered?
16. What drugs are not covered under Medicare prescription drug plans?

Filling Prescriptions

1. Which pharmacies can I use to get covered prescriptions filled?
2. Can I get prescription drugs by mail order?
3. How will a prescription mail-order service help me save money?
4. What if I'm traveling and need to fill a covered prescription?
5. Are prescriptions filled in Canada covered?

Enrolling 

1. Do I need to sign up for Medicare prescription drug coverage?
2. Is it better to enroll in a plan that provides both medical and prescription coverage?
3. Who is eligible to join a Medicare prescription drug plan?
4. How do I enroll?
5. Why would I be subject to a late enrollment penalty?
6. Is there a standard time period for people to change their coverage?
7. I just have Original Medicare (Parts A and B). Can I enroll in the Aetna Medicare Rx^® Plan?
8. I have a Medicare Supplement (Medigap) plan. Can I enroll in a Medicare Rx plan?
9. Can a child or guardian enroll a parent in a prescription drug plan?
10. What happens to my Medicare card if I enroll in a prescription drug plan?
11. What happens to my Medicare card if I enroll in a Medicare Advantage plan that has a prescription drug plan?

Member Effective Date

1. When will my Medicare prescription drug coverage begin if I enroll in an Aetna Medicare Rx^® Plan (PDP)?

Member ID Cards

1. When should I expect to receive my Aetna Medicare member ID card?
2. How can I get my covered prescriptions filled if I have NOT received my new member ID card for the Aetna Medicare Rx^® Plan (PDP)?

CVS/pharmacy Preferred Network

1. What is a preferred pharmacy?
2. Does Aetna Medicare Rx have a preferred pharmacy network?
3. Which Aetna Medicare Rx plans offer CVS/pharmacy as a preferred network?
4. What are the advantages of using the CVS/pharmacy preferred network?

General

1. When did the Medicare prescription drug coverage begin?

   The legislation passed by Congress and signed by President George W. Bush in 2003 created the Medicare Part D prescription drug benefit, giving everyone with Medicare access to prescription drug coverage effective January 1, 2006. Medicare beneficiaries may purchase prescription drug coverage from private insurance companies, such as Aetna. In addition, extra help is available for people with low incomes.* 

   back to top

2. Is it really necessary to have Medicare prescription coverage?

   The costs for prescriptions go up each year. People often face even greater medical and prescription drug costs as they age. To get Medicare prescription drug coverage, you'll need to join a Medicare prescription drug plan, such as an Aetna Medicare Rx^® Plan (PDP). 
   
   If you don’t join a Medicare drug plan when you are first eligible for Medicare Part A and/or B and you go without creditable prescription drug coverage for 63 continuous days or more, you may have to pay a late-enrollment penalty to join a plan later.

   If you were eligible to join a Medicare prescription drug plan before January 1, 2006, but did not, you may pay a penalty to join now. Medicare sets the penalty, and it increases your plan premium by 1% of the national base beneficiary premium for every month you were eligible but did not join (unless you have creditable coverage).

   back to top

3. What does a Medicare prescription drug plan cover?

   Medicare prescription drug plans cover preferred generic and brand-name drugs. Plans may have rules about what drugs are covered in different drug categories to be sure people with different medical conditions can get the treatment they need. Most plans will have a formulary, which is a list of drugs covered by the plan. The Aetna Medicare Preferred Drug list has been approved by the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program. 

   back to top

4. Does Aetna have a quality improvement program?

   Yes. We approach quality measurement and improvement with a member-centric focus on everything we do. Our programs are designed to enhance the quality of care our members receive. We use clinical data and industry-accepted, evidence-based guidelines to better inform members. And we support transparency by providing credible clinical information and tools to help doctors and members make informed decisions.

   back to top

Costs

1. Can Aetna Medicare Rx^® Plans (PDP) help me save on the costs of medications?

   Yes. Aetna negotiates discounts for medications with participating network pharmacies. The plans include ways to help you save — such as the prescription drug mail-order service and coverage for generic drugs.

   back to top

2. How much will Medicare prescription drug coverage cost (premium)?

   It depends on the plan you select and where you live. Go to Find Plans to estimate the cost of an Aetna Medicare Rx^® Plan (PDP). Some people may qualify for financial help with prescription drug coverage, often referred to as “Extra Help*.” Qualification depends on factors the federal government has outlined.

   back to top

3. Does this program benefit someone who takes only a few prescription medications each month?

   Yes. Even if you’re healthy now and take only a few medications, your prescription drug costs could increase in the future from an unexpected illness. Also, if you are eligible for Medicare but do not participate in a Medicare prescription drug plan, you may have to pay a late enrollment penalty if you decide to join a plan later.

   back to top

4. How do I pay plan premiums?

   You can pay the Medicare prescription drug plan premium directly to Aetna Medicare, have plan premiums deducted from your Social Security checks, or your employer may pay plan premiums for Medicare-eligible retirees.

   back to top

5. Which Aetna Medicare Rx^® Plan (PDP) allows me to pay the least out of my pocket to get a prescription filled?

   Compare expected costs for Aetna Medicare Rx^® Plans (PDP) available where you live by using the cost estimation tools to Find Plans. We will ask you questions about your eligibility, coverage requirements, and medications you take to help you compare the available Aetna Medicare Rx^® Plans (PDP) in your area.

   back to top

6. What do I do if I need help paying for prescription drugs?

   People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs, including monthly premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, or to see if you qualify, call:

   • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
   • The Social Security Administration at 1-800-772-1213, between 7 a.m. and 7 p.m., Monday - Friday. TTY/TDD users should call 1-800-325-0778; or
   • Your state Medicaid office.
   back to top

7. Who qualifies for help? How can I find out more and apply for help?

   Eligibility for help is based on guidelines set by the federal government. You can apply for Extra Help through the Social Security Administration or your state Medicaid office.

   To see if you qualify for getting Extra Help, call:

   • 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048, 24 hours a day/7days a week;
   • The Social Security Administration at 1-800-772-1213, between 7 a.m. and 7 p.m., Monday - Friday. TTY/TDD users should call 1-800-325-0778; or
   • Your state Medicaid office.
   back to top

8. Medicaid helped pay for my prescription drug coverage in the past. Do I have to join a Medicare prescription drug plan?

   Yes. After December 31, 2005, the Medicaid program stopped providing prescription coverage for people eligible for Medicare. (However, certain drugs that are not covered by Medicare may still be covered by your state Medicaid program.) In January 2006, Medicare began helping individuals cover their prescription drug costs. If you have full Medicaid benefits, you will be assigned to a Medicare prescription drug plan if you do not select one on your own or choose to decline Medicare prescription drug coverage completely.

   back to top

9. Will my Medicare Advantage plan premium go down if the government is helping pay for part of the Medicare prescription drug plan cost?

   If you have a Medicare Advantage plan with Medicare prescription drug coverage, the government financial help may affect your premiums, copayments or both.

   If you know how much coverage you receive, check Aetna Medicare's subsidy table for your plan type on the Low Income Subsidy page to see what your premium might be.

   back to top

Coverage

1. What is a “coverage gap?”

   Also known as the “donut hole,” the coverage gap is a phase in the benefit design of a Medicare prescription drug plan. This phase occurs when a member has reached the initial coverage limit and ends once the member has reached the true out-of-pocket threshold. A member may be responsible for 100% of medication costs during this portion of the phase, although some plans may include full or partial coverage during this phase.

   back to top

2. Do all Medicare prescription drug plans have a Coverage Gap?

   
   While all prescription drug plans have a Coverage Gap, some plans may provide some level of continuing benefit through the gap. Our Aetna Medicare Rx Plan (PDP) and the Aetna Medicare Advantage Plans with prescription drug coverage offer varying levels of coverage during the Coverage Gap. Please refer to our Summary of Benefits for a complete description of the prescription drug benefit coverage available in your area.

   back to top

3. What happens after the Coverage Gap?

   After you pay a specified amount of true out-of-pocket expenses (TrOOP) for your covered Part D medications, most of your costs for prescriptions included in the Aetna Medicare Rx^® Plans (PDP) will be covered, subject to modest cost sharing.

   back to top

4. Are both brand and generic prescription drugs covered?

   Yes. Aetna Medicare Rx^® Plans (PDP) cover both brand-name and generic prescription drugs, including many well-known brands. See the Find Prescriptions section of our website for more information.

   back to top

5. How can I find out which prescription drugs are covered?

   Go to the Find Prescriptions section of our website for more information or use our formulary finder tool to see if your medication is covered.

   back to top

6. What is the Aetna Medicare Preferred Drug List, or formulary?

   The Aetna Medicare Preferred Drug List (also known as a formulary) is a list of medications chosen by Aetna, in consultation with a team of health care professionals, including geriatric specialists. Prescription drugs on the Aetna Medicare Preferred Drug List have been chosen on the basis of sound medical data, safety and cost. Additionally:

   • The Aetna Medicare Preferred Drug list has been approved by the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program.
   • The medications on the Aetna Medicare Preferred Drug List have been approved by the Food and Drug Administration (FDA) as safe and effective.
   • Both brand-name and generic medications are on the Aetna Medicare Preferred Drug List.

   For a complete list of all prescription medications covered by Aetna Medicare prescription drug plans, please call the Member Services number listed on your Aetna Medicare member ID card between 8 a.m. and 8 p.m., 7 days a week. TTY/TDD users for the hearing or speech impaired should call: 711. You can also go to the Find Prescriptions section of the website.

   back to top

7. Can the Aetna Medicare Preferred Drug List change?

   The Aetna Medicare Preferred Drug List is updated on an ongoing basis and may change during the year. We will let affected members know at least 60 days before a medication is removed from coverage, moved to a higher cost-sharing level, or if prior authorization, quantity limit or step-therapy restrictions will be placed on a medication.

   • From time to time, Aetna reviews the Aetna Medicare Preferred Drug List to make sure it meets the criteria for safety, effectiveness and overall value. Medications may be covered at a higher copayment and/or removed from the Preferred Drug List with advance notice of the change.
   • As brand-name medications lose their patents and generic versions become available, the brand-name medication may be covered at a higher copayment.
   • The Aetna Medicare Preferred Drug List may change if a medication is taken off the market or becomes available without a prescription.
   • If the Food and Drug Administration determines a drug on the Aetna Medicare Preferred Drug List is unsafe or if the drug manufacturer removes the drug from the market, we will immediately remove it from the Aetna Medicare Preferred Drug List.

   For updated information about the medications covered by your plan, please go to Find Prescriptions or call the Member Services number listed on your Aetna Medicare Member ID card. TTY/TDD users for the hearing or speech impaired should call: 711.

   back to top

8. What if a medication I’m already taking is not included on the Aetna Medicare Preferred Drug List?

   You can find details regarding the transition process and exceptions for medications not covered under the plan in the Aetna Medicare Rx Exceptions, Appeals and Grievances section of this website.

   back to top

9. How do I request an exception to the Aetna Medicare Preferred Drug List?

   You can ask Aetna to make a medical exception to our coverage rules. There are several types of exceptions that you can ask us to make:

   • If you are enrolled in a plan with a closed formulary, you can ask us to cover your medication even if it is not designated as covered on the Aetna Medicare Preferred Drug List.
   • You can ask us to waive coverage restrictions or limits on your medication. For example, for certain medications Aetna limits the amount of the medication that we will cover. If your medication has a quantity limit, you can ask us to waive the limit and cover a higher quantity.

   When you are requesting an exception, you should submit a statement from your doctor supporting your request. Exception requests are processed in accordance with CMS requirements and timeframes. Refer to the Request for Prescription Drug Coverage Determination Form for more information.

   back to top

10. What are generic medications?

    • A generic medication has the same active-ingredient formula as the brand-name medication.
    • Generic medications usually cost less than brand-name medications and are approved by the Food and Drug Administration (FDA).
    • On the Aetna Medicare Preferred Drug List, generic medications are listed in lowercase italicized letters (for example: ranitidine), and brand-name medications are listed in all capitalized letters (for example: ZANTAC).

    For updated information about the medications covered by your plan, please go to Aetna Medicare Rx^® — Find Prescriptions or call the Member Services number listed on your Aetna Medicare Member ID card. TTY/TDD users for the hearing or speech impaired should call: 711.

    back to top

11. Do Aetna Medicare Rx^® Plans (PDP) cover wheelchairs and durable medical equipment (DME)?

    Wheelchairs and durable medical equipment are not included in the Medicare prescription drug coverage. They may be covered under Medicare Part A and/or B.

    back to top

12. Do the Aetna Medicare Rx^® Plans (PDP) cover insulin and diabetic supplies?

    Yes. Insulin and some diabetic supplies are covered. Testing supplies such as lancets and test strips are covered under Medicare Part B.

    back to top

13. What if I already receive prescription drug coverage as part of my employer's retiree benefits?

    It’s up to you to decide what works best for you. If an employer or union offers prescription drug benefits, you should compare the plan and costs with those offered under the Aetna Medicare prescription drug plans. Also review any limitations the employer plan has for re-enrollment (i.e. if you opt out of your employer’s retiree plan, you may not have an opportunity to re-enroll at a later date.) It is an employer's responsibility to inform their Medicare eligible retirees/employees if the prescription drug plan offered is on average, at least as good as the standard Medicare Part D benefit — that is, if it is creditable coverage.

    Note: If your retiree plan is not considered “creditable coverage” and you choose not to purchase a Medicare prescription drug plan, you may have to pay more each month (penalty) if you want to join a Medicare prescription plan later.

    back to top

14. What is “creditable coverage?”

    This is coverage that is, on average, at least as good as the standard Medicare prescription drug coverage the government has outlined. This is important if you decide not to select a Medicare prescription drug plan during your initial election period — because you can join a Medicare Part D plan after your initial election period without a penalty if you have coverage that is at least as good as basic Medicare prescription drug coverage.

    back to top

15. I have coverage through the Veteran's Administration (VA). Will my prescriptions continue to be covered?

    VA benefits will not be affected. Medicare beneficiaries who currently have prescription drug benefits through the VA will be able to continue to obtain their prescriptions through the VA coverage.

    back to top

16. What prescription drugs are not covered under Medicare prescription drug plans?

    
    
    1. Drugs that are covered under Medicare Part A or Part B
    2. Drugs purchased outside the U.S.
    3. Drugs used for anorexia, weight loss, or weight gain
    4. Drugs used to promote fertility
    5. Drugs used for cosmetic purposes or hair growth
    6. Drugs used for SYMPTOMATIC relief of cough and colds
    7. Prescription vitamins and mineral products, EXCEPT prenatal vitamins and fluoride preparations
    8. Non-prescription drugs (over the counter or OTC)
    9. Covered outpatient drugs for which the manufacturer seeks to require associated tests or monitoring services purchased exclusively from the manufacturer or its designee as a condition of sale
    10. Barbiturates (such as phenobarbital) and benzodiazepines (such as Valium, Xanax, Restoril), unless included as an enhanced benefit
    11. Drugs used for the treatment of sexual or erectile dysfunction
        
    back to top

Filling Prescriptions

1. Which pharmacies can I use to get covered prescriptions filled?

   More than 65,000 retail pharmacies participate in the Aetna Medicare Rx^® Plan (PDP) network. This includes both national pharmacy chains like CVS, Costco, and Walgreens, as well as regional chains and independent pharmacies like Longs Drugs. Find participating pharmacies using DocFind. Enter your location, make a selection under “Pharmacies,” then choose “Aetna Medicare (All Plans)” and Search Criteria.

   back to top

2. Can I get prescription drugs by mail order?

   If you take certain medications on an ongoing basis, you might be able to save money getting them by mail order. Covered prescription drugs are delivered right to your front door. If you depend on prescription medications to treat chronic conditions and diseases — such as arthritis, diabetes, heart conditions, asthma, high blood pressure and high cholesterol — you can order covered medications through the easy-to-use, convenient Aetna Rx Home Delivery^® service, Aetna’s preferred mail-order service. See Aetna's Preferred Drug List for availability of medications through Aetna's Mail Order Drug facility.

   back to top

3. How will a prescription mail-order service help me save money?

   Aetna Rx Home Delivery^® is our network mail-order service designed to help you manage your health while watching your budget. Ordering medications to help with problems like arthritis, diabetes, heart conditions, asthma, high blood pressure, and high cholesterol is easy and convenient. Among its advantages are:

   • Convenience. You can place your order 24-hours a day from your home and have your medication delivered to you. No waiting in line at the pharmacy or multiple trips dropping off and picking up your prescriptions.
   • Cost savings. Depending on the plan and the medication you use, you may be able to save money on a three-month supply of covered medications. Standard shipping is always free.
     
   • Simplicity. Aetna’s easy, two-step process makes ordering maintenance medications a snap.
   • Quality service. Registered pharmacists check your orders for accuracy and are available 24 hours a day, 7 days a week, in case of emergencies.

   Also, the Aetna Pharmacy website can help you stay informed about your prescription drugs and learn how to use your prescription drug benefits wisely. You can get information about hundreds of prescription drugs, possible side effects, generic substitutions and more.

   back to top

4. What if I'm traveling and need to fill a covered prescription?

   You can fill a prescription at any of the pharmacies participating in the Aetna Medicare network, no matter where they are in the United States. Also, you can use the Aetna Rx Home Delivery^® prescription mail-order service.

   back to top

5. Are prescriptions filled in Canada covered?

   Only drugs sold and dispensed within the United States may be covered under the Medicare prescription drug plan.

   back to top

Enrolling

1. Do I need to sign up for Medicare prescription drug coverage?

   The Medicare prescription drug program is completely voluntary. If you want Medicare prescription drug coverage, you can choose to enroll in a plan that meets your needs. Delaying enrollment could result in having to pay a premium penalty. If you have Medicare, you can either enroll in a Medicare prescription drug plan (PDP) or in a Medicare Advantage plan with Medicare prescription drug coverage (MA-PD).
   
   When you have Original Medicare (Parts A and B) coverage, or a Medicare Supplement plan, or a PFFS (Private Fee-for-Service) plan that does not include prescription drug coverage, you can enroll in a standalone Medicare Prescription Drug (PDP) plan. Aetna has Medicare-approved prescription drug plans available throughout the country and Medicare Advantage plans in some areas.

   In addition, if you have Medicare and are receiving prescription drug coverage through a group plan offered by a former employer/union, you can continue this coverage. You will need to contact your group's benefits administrator to find out more about this coverage to ensure it is considered creditable coverage.

   back to top

2. Is it better to enroll in a plan that provides both medical and prescription coverage?

   It’s up to you. Medicare prescription drug coverage can be included in a Medicare Advantage plan (an HMO, PPO or a PFFS). A Medicare prescription drug plan can also be combined with a Medicare Supplement (Medigap) plan. Aetna Medicare can give you information that can help you choose a plan that works for your individual needs. Learn more by visiting our Aetna Medicare Choices section of the site.

   back to top

3. Who is eligible to join a Medicare prescription drug plan?

   Anyone eligible for Medicare Part A and/or B can join a Medicare prescription drug plan, such as one of the plans Aetna Medicare offers. Anyone who is eligible will be accepted, regardless of current health condition. You must also live in the service area of the plan you are choosing in order to be enrolled.

   back to top

4. How do I enroll?

   Enrolling is easy! Follow these simple steps:

   1. Enroll online: Use our safe and secure enrollment tool.
   2. Enroll by phone: Call an Aetna Medicare representative at 1-800-529-5586 (TTY/TDD 711), Monday - Sunday, 8 a.m. to 8 p.m. local time.
   3. Enroll by mail: Complete and sign your enrollment form, then mail it to:
   • Aetna Medicare
   • P.O. Box 14088
   • Lexington, KY 40512-4088

   If you need help, call an Aetna Medicare representative at 1-800-529-5586 (TTY/TDD 711), Monday - Sunday, 8 a.m. to 8 p.m. local time. We'll be happy to help you.

   back to top

5. Why would I be subject to a late enrollment penalty?

   Some members are required to pay a late enrollment penalty because they did not join a Medicare drug plan when they first became eligible or because they had a continuous period of 63 days or more when they didn't have “creditable” prescription drug coverage. (“Creditable” means the drug coverage is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.) For these members, the late enrollment penalty is added to the plan’s monthly premium. Their premium amount will be the monthly plan premium plus the amount of the late enrollment penalty.

   • If you are required to pay the late enrollment penalty, the amount of your penalty depends on how long you waited before you enrolled in drug coverage or how many months you were without drug coverage after you became eligible.
   • If you have a late enrollment penalty, it is included as part of your monthly plan premium. If you do not pay your monthly plan premiums, you could be disenrolled.
   back to top

6. Is there a standard time period for people to change their coverage?

   Yes, the federal government has established periods when a person can join and change his or her Medicare prescription drug coverage. See the website section Important Dates to Remember for more information.

   back to top

7. I just have Original Medicare (Parts A and B). Can I enroll in the Aetna Medicare Rx^® Plan (PDP)?

   Yes, if it is during a valid election period. See the website section Important Dates to Remember for more information. You may also Enroll Online.

   back to top

8. I have a Medicare Supplement (Medigap) plan. Can I enroll in a Medicare Rx plan?

   Yes. If your Medicare Supplement plan has drug coverage and you enroll in a Medicare prescription drug plan, you must contact your Medicare Supplement issuer to let them know you have joined a Medicare prescription drug plan. Your prescription coverage will be removed from your Medicare Supplement policy if you enroll in a Medicare prescription drug plan.

   back to top

9. Can a child or guardian enroll a parent in a prescription drug plan?

   Generally, only a Medicare beneficiary can enroll. However, another individual (such as a court-appointed guardian or legal representative) may complete an enrollment or disenrollment request on behalf of the Medicare eligible beneficiary.

   back to top

10. What happens to my Medicare card if I enroll in a prescription drug plan?

    Keep it. The prescription drug plan card will not replace your Medicare card. An Aetna Medicare Rx^® Plan (PDP) card will be sent to individuals who join Aetna and can be used when purchasing prescription drugs.

    back to top

11. What happens to my Medicare card if I enroll in a Medicare Advantage plan that has a prescription drug plan?

    Keep it, but only use it for discounts and general identification purposes. You must use your Aetna Medicare member ID card when you require medical services or to obtain covered prescription drugs.

    back to top

Member Effective Date

1. When will my Medicare prescription drug coverage begin if I enroll in an Aetna Medicare Rx^® Plan (PDP)?

   Members may enroll in the plan only during specific times of the year. Your effective date will depend on when you apply for coverage. If you enroll during the Annual Election Period (AEP), between October 15 and December 7, your coverage will be effective January 1.
   
   If you enroll during your initial election period for Medicare, and you apply before the first day of the month you become eligible for Medicare Part A and/or Part B, your coverage will begin on the first of the month you are eligible. For example, if you enroll in Aetna Medicare on January 23 and you are Medicare eligible on February 1, your Medicare plan will begin on February 1.
   
   There may be other times during the year you can enroll in an Aetna Medicare Rx® Plan (PDP). Contact the plan for additional information.

   back to top

Member ID Cards

1. When should I expect to receive my Aetna Medicare member ID card?

   Our goal is to send you an Aetna Medicare member ID card as soon as possible. Please contact Aetna Medicare Member Services if you have questions.

   Call:

   Aetna Medicare Rx® Plans (PDP) (individuals)	1-877-238-6211
   Aetna Medicare Plan (HMO) and Aetna Medicare Plan (PPO) (individuals)	1-800-282-5366
   Aetna Medicare Rx® Plans (PDP) (members of group plans)	1-877-238-6211
   Aetna Medicare Plan (HMO) and Aetna Medicare Plan (PPO) (members of group plans)	1-800-282-5366
   Aetna Medicare Plans (Aetna retirees)	1-800-282-5366

   back to top

2. How can I get my covered prescriptions filled if I have NOT received my new member ID card for the Aetna Medicare Rx^® Plan (PDP)?

   Aetna Medicare members can get covered prescriptions filled at participating pharmacies if they have not received an Aetna Medicare member ID Card. To get your covered medications, you can:

   1. Ask your pharmacist to call Aetna. If you're eligible for prescription drug coverage and Aetna has processed your application in our system and submitted it to CMS, we will allow the covered prescription to process.
   2. Print a temporary Aetna Medicare member ID card from Aetna Navigator^®, Aetna's secure member website. If a member has been processed in our system, he/she can print a temporary Aetna Medicare member ID card online after registering for access to Aetna Navigator.
   3. Pay for your covered medications and submit a prescription drug claim form to Aetna once your enrollment is complete. NOTE: This is a temporary process. Get a claim form here.

   If CMS notifies Aetna that you are not eligible for Medicare prescription drug coverage (Part D), you will not be reimbursed for your medications.

   back to top
   

CVS/pharmacy Preferred Network

1. What is a preferred pharmacy?

   Preferred pharmacies are pharmacies in our network where we have negotiated lower cost sharing for members for covered drugs than at other network pharmacies. However, you will usually have lower drug prices at these other network pharmacies than at out-of-network pharmacies. You may go to either of these types of network pharmacies to receive your covered prescription drugs. But, you will have lower prescription drug costs for most medications at the preferred network pharmacy.

back to top

2. Does Aetna Medicare Rx have a preferred pharmacy network?

   Yes, Aetna Medicare Rx offers the CVS/pharmacy network as its preferred pharmacy network for the Aetna CVS/pharmacy Prescription Drug Plan (PDP). Note that Longs Drugs in Hawaii is owned by CVS/pharmacy and is also a part of the preferred network.

back to top

3. Which Aetna Medicare Rx plans offer CVS/pharmacy as a preferred network?

   The Part D plan named, “Aetna CVS/pharmacy Prescription Drug Plan (PDP)” utilizes CVS/pharmacy as its preferred pharmacy network. This plan is offered in 43 states and DC—it is not offered in AK, AR, CO, ID, OR, UT, WA.

back to top

4. What are the advantages of going to a CVS/pharmacy in that plan?

   The Aetna CVS/pharmacy Medicare Prescription drug (PDP) offers outstanding value plus assistance from experienced CVS/pharmacy pharmacists and the convenience of shopping at your neighborhood CVS/pharmacy.

• Members save $6 in copays on preferred generics and $10 in copays on non-preferred generics and preferred brand name drugs at CVS/pharmacy locations during the initial coverage stage of the plan.
• There are more than 7,200 CVS/pharmacy locations across the U.S.
• Many CVS/pharmacy locations offer 24-hour or extended-hour services and/or drive-through pharmacies.
• Other pharmacies are available in our network and higher costs may apply. Members may fill their prescriptions at any of the 65,000 pharmacies in Aetna's Medicare network, including the more than 7,200 CVS/pharmacies.
  
  

back to top

* You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday - Friday TTY users should call 1-800-325-0778; or your state Medicaid office. 

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. A Medicare approved Part D sponsor. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1 of each year. Limitations, copayments, and restrictions may apply. See plan documents.

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. Plan features and availability may vary by location and are subject to change each year.

You must be entitled to Medicare Part A or B and continue to pay your Part B premium and Part A, if applicable. Medicare beneficiaries may enroll in a plan only during specific times of the year. To obtain additional information, please contact Aetna Medicare. 

In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Pharmacy clinical programs such as prior authorization, step therapy, and quantity limits may apply to your prescription drug coverage.  

This material is for informational purposes only. Not all health services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna’s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.