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Print a prescription drug claim form

Print a prescription drug claim form (Spanish)

Medical, Dental, Hearing, Vision & Vaccine Reimbursement Form

Medical, Dental, Hearing, Vision & Vaccine Reimbursement Form (Spanish)

How to enroll in an Aetna Medicare plan

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)

Medication Order Form for Aetna Rx Home Delivery

Medication Order Form for Aetna Rx Home Delivery (Spanish)

Medication Action Plan

Medication Action Plan (Spanish)

Personal Medication List

Personal Medication List (Spanish)

Learn more about requesting an exception or filing a grievance or appeal:

Access forms and learn what steps to take

We'll call you

Schedule a call with a licensed agent to learn more.

Schedule a call

Call us

Talk to a licensed agent

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We'll come to you

Meet with ${anCompany} Medicare representative to learn more about your options.

Schedule a visit

Disclaimers

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 not a complete description of benefits. Call 1-855-335-1407 (TTY: 711) for more information.

Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Participating physicians, hospitals and other health care providers are independent contractors. They're neither agents nor employees of ${company}. The availability of any particular provider can't be guaranteed. Provider network make-up is subject to change.

Get a Form

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

We'll call you

Call us

We'll come to you

Disclaimers

You are now leaving the Aetna Medicare website.

You are now leaving our Medicare website.

Select your plan to log in or register

Select your plan to request a directory