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Claims (collapsed): Medical Claim Form

Prescription Drug Claim 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.

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

You can also visit Medicare's complaint website for more information:
Medicare's Complaint Form

We're here to help (collapsed): Email us or call Member Services at the number on your ID card.

Don’t have your ID card handy?
Find a phone number

We speak your language (collapsed): We have free interpreter services to answer questions you may have about our health or drug plan. Choose a plan below to learn how to use this service.

Medicare Advantage Plans
Prescription Drug Plans (PDP)

¿Habla español?
Visite nuestro sitio en español

我们提供免费的翻译服务，帮助您解答关于健康或药物保险的任何疑问 (Chinese)

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

This information is available for free in other languages. Please call our customer service number at 1-800-282-5366 (TTY: 711), seven days a week, from 8 a.m. to 8 p.m. from October 1 to February 14 and Monday through Friday, from 8 a.m. to 8 p.m. from February 15 to September 30.

Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-800-282-5366 (TTY: 711). Horario de atención: de 8 a.m. a 8 p.m., los siete días de la semana, del 1 de octubre al 14 de febrero, y de 8 a.m. a 8 p.m., de lunes a viernes, del 15 de febrero al 30 de septiembre.

本資訊也有其他語言的免費版本可供選擇。請致電 1-800-282-5366 與我們的客戶服務部聯絡以瞭解更多資訊。 （聽障人士請致電 711。）辦公時間為每週 7 天、當地時間上午 8 時至晚間 8 時。

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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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What coverage do you need?

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