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Managing my costs
To submit a claim for reimbursement, please download, complete and submit the forms below. You will find submission instructions and when you can expect to receive reimbursement within each form.
No printer? No problem. Here’s what to send us for reimbursement.
To request coverage for a medical service or prescription drug, you must follow a few steps. For example, the process to request a coverage decision for medical services can be different than the process for prescription drugs. You can learn more about coverage decisions by selecting this link.
An appeal is a formal way of asking us to review and change a coverage decision we made. The appeals process can differ depending on what type of medical service you’re trying to appeal. You can learn more about how to appeal a coverage decision for medical coverage or prescription drugs at our appeals and grievances center.
The Medicare Extra Help program is for those with limited income and resources. It helps pay for Medicare Prescription drug costs if you qualify.
Managing my plan
If you’re moving to a new address or getting a new phone number, please let us know right away. Just call Member Services at the number on your ID card. Based on where you move, you may need to enroll in a new plan.
If you get Aetna Medicare coverage through an employer, union, or retiree plan, you may need to contact your benefits administrator to update your address or phone number.
If you need a new or additional ID card, you can view and print one within your secure member website. A digital or printed card is identical to a plastic ID card. If you’re unable to log in or do not have an account, please call Member Services to log in or replace a lost card.
There are two main time periods when you can change or leave your Medicare Advantage (Part C) or prescription drug (Part D) plan.
During Medicare's annual election period: 10/15 – 12/7
From October 15 through December 7 each year, you can decide to keep your current plan or select a new plan. Your coverage will begin on January 1 of the following year, if we get your request during the annual election period.
Medicare beneficiaries may also enroll in an Aetna Medicare plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
During a special enrollment period granted to you for certain situations
In certain situations, you can change your Medicare plan outside of Medicare’s annual election period. Some examples include if you:
- Move out of your plan’s service area
- Lose other creditable prescription drug coverage (prescription drug coverage that pays out, on average, at least as much as a Medicare Part D plan)
- Live in a long-term care facility (like a nursing home)
- Have Medicaid
If you get coverage from an employer or group health plan, review the information they provided to see what options are available to you.
Generally, your membership on your current plan will end on the last day of the month after we get your request to switch to Original Medicare or another plan.
We’re so sorry for your loss. And we're here to help and support you during this challenging time.
Have you already notified the Social Security Administration, or SSA, of your loved one’s death? If not, you should do so right away by calling 1-800-772-1213 (TTY: 1-800-325-0778). Connecting with the SSA is the only way to officially close your loved one's account. You may still receive premium bills from us until the account is closed.
If you have questions about their plan or premium, call us.
Managing my care
Aetna plans have a home delivery option through the CVS Caremark® Mail Service Pharmacy. To get started with home delivery, please visit the CVS Caremark® Mail Service Pharmacy page. Not all benefits and services are available in all plans.
If you need help just once, you can give us your permission by phone. We can speak with that person during the call.
If you want to appoint someone to act as a long-term care manager or authorized representative, 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 about benefits, coverage, claims, bills and more.
Return the completed form to us at the address or fax number shown on the form.
It’s important to know:
The PHI form doesn’t override Medicare Power of Attorney documents. You don’t need to complete the PHI form if you have a Power of Attorney (POA).
The PHI form is only good for one year. You need to complete a new form each year for a representative to continue to assist you.
You need to complete a separate form (see below), if you need help filing an initial request for coverage, a grievance or an appeal.
You have a few options when filing a complaint. You can:
- Call us at the number on your ID card
- Submit a complaint online
- Print a complaint form and fax or mail it to the address shown on the form
We’ll get back to you within 30 days (24 hours if you request a faster response). To send a complaint to Medicare, complete the Medicare Electronic Complaint form.
You can select or change your PCP online through the secure member site. Or you can call us at the number on your member ID card. You may need to choose your PCP from your plan’s network.
Aetna Medication Therapy Management (MTM) programs help you and your doctor manage your medications safely. Visit our MTM information page to learn more about these programs and see if you qualify.
Aetna® and CVS Caremark® Mail Service Pharmacy are part of the CVS Health® family of companies.
Have other questions?
A Member Services agent can help you get answers.