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Claims & Reimbursements (collapsed): Medical Claim Form

Prescription Drug Claim Form

Reimbursement Form
Enrollment (collapsed): How to enroll in an Aetna Medicare plan
Give another person permission to help manage your care (collapsed): Let someone else talk to us about your health or coverage

One-time only: You can give us your permission by phone. We can speak with that person during that call.

On an ongoing basis: You may want someone to speak with us more often. If so, you’ll need to mail us an Authorization for Release of Protected Health Information (PHI) form. It lets this person access your personal health information. They can also speak with us on your behalf.

Open and print the PHI form

Open and print the PHI form (Spanish)

Let someone file a grievance (complaint), ask for coverage or make an appeal for you

You can choose someone to do all of the above. This person is your appointed representative. An appointment is good for one year from the date that you and your representative sign an Appointment of Representative form.

Fill out this form below and mail it to us. Any time your representative makes a request for you, they should send us a signed copy. You'll leave Aetna Medicare and go to the CMS website if you link to the form.

Appointment of Representative CMS Form

Appointment of Representative CMS Form (Spanish)
Prescription drugs (collapsed): Medication Order Form for Aetna Rx Home Delivery

Medication Action Plan

Medication Action Plan (Spanish)

Personal Medication List

Personal Medication List (Spanish)
Member exceptions, appeals and grievances (collapsed): Learn more about requesting an exception or filing a grievance or appeal:
Access forms and learn what steps to take

Find the forms you need

Let someone else talk to us about your health or coverage

Let someone file a grievance (complaint), ask for coverage or make an appeal for you

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You are now leaving the Aetna Medicare website.

You are now leaving the Aetna Medicare website.

You are now leaving our Medicare website.

What 2016 coverage do you need?

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What 2016 coverage do you have?

What 2017 coverage do you have?

Doctors & Hospitals

Mental Health Providers

What coverage do you need?

Choose a 2017 plan type to enroll

Choose a 2016 plan type to enroll

Choose a plan type (and year) to enroll

What coverage do you need?

Get a Form

Find the forms you need

We're here to help

You are now leaving the Aetna Medicare website.

You are now leaving the Aetna Medicare website.

You are now leaving our Medicare website.

Select your plan to log in or register

What 2016 coverage do you need?

Select your plan to request a directory

What 2016 coverage do you have?

What 2017 coverage do you have?

Doctors & Hospitals

Mental Health Providers

What coverage do you need?

Choose a 2017 plan type to enroll

Choose a 2016 plan type to enroll

Choose a plan type (and year) to enroll

What coverage do you need?