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Plan benefits & forms

Medicare plans have many different details and forms, so we’ve organized everything together into one convenient place.

Your Aetna plan benefits & Star Ratings


Knowing more about your plan can help you get the most from your benefits and covered services. Find your plan’s Summary of Benefits, Formulary (list of covered drugs) and other coverage details below. Your member ID card shows your plan’s name. See a word or term you don't know? Check our glossary.

Evidence of Coverage (EOC), Star Rating & Formulary

Review your Evidence of Coverage to learn about comprehensive plan details, and your rights and responsibilities. You can request a copy of your Evidence of Coverage if you need one.

Evidence of Coverage (EOC) – English (PDF)

Evidence of Coverage Rx (EOC) – English (PDF)

Star Rating - English (PDF)


Formulary – English (PDF)


Dental plan information


The Aetna DMO plan requires that you select a Primary Care Dentist (PCD) before receiving dental services. Dental services received without selecting a PCD will not be covered. Once you have selected your PCD, call the Aetna Dental Member Services at 1-888-905-7348 (TTY: 711), Monday to Friday, 8 AM to 6 PM ET with your selection. Aetna will send you a Dental ID card with the name of the PCD.


For questions about Aetna dental plans, call Aetna Dental Member Services at 1-888-905-7348 ${tty}, Monday to Friday, 8 AM to 6 PM ET.

Find Medicare forms


See below for helpful resources for managing your plan and how to get started with common requests.



File claims & reimbursement requests

Give someone permission to manage your care

Manage your medications

Exceptions, appeals & grievances

Additional information

We're here to help

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