Select your state, county and plan name below to find your:
The plan name is listed on your member ID card.
Get coverage from an employer or group health plan? Review the plan benefit information you received from them.
Have Medicare Supplement insurance (Medigap)? View your benefits
You can request a copy of your Evidence of Coverage or Formulary if you need one.
Looking for referral and pre-approval requirements?
Check your plan’s Evidence of Coverage.
The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations. They issue these when a service’s or drug’s coverage rules change.
We help you get medically necessary health care services in the most cost-effective way under your health plan. And we work with you and doctors to evaluate services for medical appropriateness, timeliness and cost.
Doctors and health care companies continuously develop new technologies. This can include anything from a new procedure to a new way to use a device.
When we learn about a new technology, we:
If you’re enrolled in a standard Aetna Medicare Plan (HMO)
If you get coverage from an out‐of‐network provider, your plan won’t cover their charges. Medicare and Aetna Medicare won’t be responsible either.
Generally, you must get your health care coverage from your primary care physician (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.
You’ll need to get a referral from your PCP for covered, non‐emergency specialty or hospital care, except in an emergency and for certain direct‐access service. There are exceptions for certain direct access services.
You must use network providers, except for:
If you get routine care from out‐of‐network providers, Medicare and Aetna Medicare won’t be responsible for the costs.
If you’re enrolled in Aetna Medicare Plan (PPO)
You have the flexibility to receive covered services from network providers or out‐of‐network providers. Out‐of‐network/non‐contracted providers are under no obligation to treat Aetna Medicare members, except in emergency situations. For a decision about whether we’ll 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 us or see your Evidence of Coverage for more information, including the cost share for out‐of‐network services.
Although you don’t have to choose a primary care physician, we encourage you to do so. If you receive covered services from an out‐of-network doctor, it’s important to confirm that they:
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