Claims and reimbursement (ask us to pay you back)
Find the forms you need
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Get paid back for prescriptions
If you were billed by a pharmacy for a covered prescription drug, mail us your completed form to request reimbursement. |
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Get reimbursed for paying provider bills
If you were billed for covered services by a medical, dental, vision, hearing or vaccine provider, mail us your completed form to ask for reimbursement. |
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No printer? Learn what to send us for reimbursement |
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Give someone permission to help with your care |
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Let someone talk to us about your health or coverage
Call us with a caregiver or someone else on the line to give them permission to speak with us (just one time, on that call). Or, mail us a completed PHI (protected health information) form to give them permission more often. |
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Let someone make requests for you
Give a caregiver or another person permission to file a complaint (grievance), ask for coverage or make an appeal for you. Just have them sign your completed Appointment of Representative form and send it to us. This person is then your appointed representative for one year from the date that you both sign an Appointment of Representative form. |
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Exceptions, appeals and grievances |
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Complaints and coverage requests
Please come to us if you have a concern about your coverage or care. Call us at the number on your member ID card, or learn more first. |
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Disenrollment (leaving or canceling a plan) |
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Leave or cancel my Medicare Advantage (MA) or Medicare Advantage Prescription Drug (MAPD) plan
Call us at the number on your ID card if you want to leave or cancel your current plan and not join another one. Or, select your current plan and find its specific phone number on our Contact Member Services page. We’ll let you know your options. Like joining a plan, there are only certain times when you can disenroll1. You may also download, complete and submit a disenrollment form — use the PDF link for your plan below to print its form: Medicare Advantage Plan Disenrollment Form Medicare Advantage Plan Disenrollment Form - Español
Please complete the relevant form and mail it to: Aetna
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Leave or cancel my prescription drug plan (PDP)
If you want to cancel or switch your Medicare Part D plan (PDP) coverage, you should find out your options. Learn all about how and when to disenroll. |
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1If you don't have creditable coverage for 63 days or more, you may have to pay a late enrollment penalty. For example, creditable coverage from an employer or union is expected to pay, on average, at least as much as Medicare's standard prescription drug coverage. You can generally keep your coverage without paying a penalty if you decide to enroll in Medicare prescription drug coverage later.