Aetna Medicare Choices

Aetna Medicare Rx Plan (PDP): Exceptions, Appeals and Grievances

We understand the importance of having the coverage you need — and that includes your prescription drugs. If you're taking a medication that's not currently covered by your Aetna Medicare Rx^® Plan (PDP), you have several options:

• If you, your appointed representative or your prescriber would like to initiate a coverage determination or exception request, please fill out the necessary information in the secure online form and submit it when complete. Complete the electronic form for a coverage determination or an exception.
• If you received a denial to your coverage determination or exception request, you can appeal to have Aetna Medicare make a decision on the benefits you feel you are entitled to receive. Complete the electronic Aetna Medicare Rx Plan Redetermination (Appeals) form.
• For grievances to address your complaints or problems, you may contact our Member Services Department at the number on the back of your member ID card or complete the online grievance form. Complete the electronic grievances form.

For more complete information about the various Aetna Medicare appeals processes, download Medicare Prescription Drug Coverage Determinations, Exceptions, Appeals, and Grievances Information Y0001_M_OT_WB_10926_R2 CMS Approved (9 pages, 106kb). 

You can find Summary of Benefits information and Medicare Contact Information in the Help and Resources section of this website. Paper versions of the Exceptions, Appeals and Grievances Forms are also found in the Help and Resources section at the bottom of the Other Forms and Documents tab. 

If you'd like to speak with the Office of the Medicare Ombudsman (OMO) for help with a complaint, grievance, or information request, visit the website of the Ombudsman on Medicare.gov.