Aetna Medicare Plans
Aetna Medicare Rx Plan (PDP): Requests for Coverage, Appeals and Grievances
We know it's important to have the coverage you need. That includes coverage of your prescription drugs.
What can I do if my medication isn't covered or is on the formulary but needs prior authorization (PA)?
If we don't currently cover your medication, you can ask for coverage by completing the online Request for Prescription Drug Coverage Determination Form.
If we deny your request, you can appeal our decision. Simply complete an online Request for Redetermination for an Aetna Medicare Prescription Drug Denial. Or you can fax your request to 1-860-907-3984.
What can I do if I have a complaint?
If you have a complaint (grievance) call us at 1-877-238-6211 (TTY:711). Or complete the online Aetna Medicare Advantage Plan or Prescription Drug Plan Grievance Form.
Where can I find my Summary of Benefits and Medicare contact information?
You can find your plan's Summary of Benefits along with Medicare contact information in the Help and Resources section of this website. Downloadable versions of the above forms are also available in this section.
Need more information?
Learn how we make coverage decisions and handle your appeals and complaints. Download and read Medicare prescription drug coverage decisions, exceptions, appeals, and grievances.
If you'd like to get an aggregate number of appeals, grievances and exceptions filed with Aetna Medicare, call us at 1-800-282-5366 (TTY: 711), from 8 a.m. to 8 p.m., local time, seven days a week.
If you have questions about the status of your exception, appeal or grievance, call us at 1-877-238-6211 (TTY: 711), from 8 a.m. to 8 p.m., local time, seven days a week.
You can contact the Office of the Medicare Ombudsman (OMO) for help with a complaint, grievance, or information request. To learn more, go to the Website of the Ombudsman at: http://www.cms.gov/Center/Special-Topic/Ombudsman-Center.html?redirect=/center/ombudsman.asp.
If you prefer to file a grievance through Medicare, click on the following link: Medicare Electronic Complaint Form.
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