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Claims and reimbursement (ask us to pay you back)

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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.

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.

No printer? Learn what to send us for reimbursement

Claims and reimbursement (ask us to pay you back)

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.

Choose PDF language

Claims and reimbursement (ask us to pay you back)

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.

Choose PDF language

Claims and reimbursement (ask us to pay you back)

No printer? Learn what to send us for reimbursement

Choose PDF language

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.

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.

Give someone permission to help with your care

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.

Choose PDF language

Give someone permission to help with your care

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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Order prescriptions by mail

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Medication order form for CVS Caremark® Mail Service Pharmacy

Order prescriptions by mail

Medication order form for CVS Caremark® Mail Service Pharmacy

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Exceptions, appeals and grievances

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. 

Exceptions, appeals and grievances

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. 

Disenrollment (leaving or canceling a plan)

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
PO Box 7405
London, KY 40742


Timing Considerations: 
If there are 10 days or fewer left until the end of the month, please fax the form to 1-866-756-5514. If you leave us during the annual election period, your last day of coverage is usually Dec. 31.


Important Note:
 If you change from a Medicare Advantage plan that includes prescription drug coverage to a Medicare prescription drug plan, this will disenroll you from your Medicare Advantage plan. You’ll return to Original Medicare if you switch from a Medicare Advantage plan (with drug coverage) to a Medicare prescription drug plan.

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.

Disenrollment (leaving or canceling a plan)

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
PO Box 7405
London, KY 40742


Timing Considerations: 
If there are 10 days or fewer left until the end of the month, please fax the form to 1-866-756-5514. If you leave us during the annual election period, your last day of coverage is usually Dec. 31.


Important Note:
 If you change from a Medicare Advantage plan that includes prescription drug coverage to a Medicare prescription drug plan, this will disenroll you from your Medicare Advantage plan. You’ll return to Original Medicare if you switch from a Medicare Advantage plan (with drug coverage) to a Medicare prescription drug plan.

Disenrollment (leaving or canceling a plan)

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.

 

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.