Plan benefits & forms

Call us with your caregiver or another person on the line to give them permission to speak with us (just one time, while on that call). Or you can mail us a completed Protected Health Information (PHI) form to give them permission on a regular basis.

PHI form - English (PDF) | Español (PDF)

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 the 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 Center for Medicare & Medicaid Services (CMS) website if you link to the form. 

Appointment of Representative CMS Form - English (PDF) | Español (PDF)

Complete and return this form to get your prescriptions delivered to you. 

Medication order form for CVS Caremark^® Mail Service Pharmacy - English (PDF) | Español (PDF)

Learn more about Rx home delivery

Complete these forms with your Medication Therapy Management (MTM) providers, and update them (as needed) with every doctor, pharmacist, nurse or caregiver you see. Take notes with your Medication Action Plan to remember medical advice, important things to do and questions to ask. Use your Personal Medication List to save and update your medication history.

Medication Action Plan - English (PDF) | Español (PDF)

Personal Medication List - English (PDF) | Español (PDF) 

Explore MTM resources

We want to be your first stop when you have a concern about your coverage or care. Call us at the number on your member ID card, or learn more here.

See how to get started

While you can find these documents online, sometimes you may need a printed version mailed to you.  

Request a printed Evidence of Coverage (EOC)
 

Request a printed Provider Directory – Call us at ${groupPhoneNumber} (TTY: 711), ${memberhours}.

Request a printed formulary

Medicare Helpline & Website - Get general or claims-specific Medicare information, request documents in alternate formats and make changes to your Medicare coverage. Call 1-800-MEDICARE (1-800-633-4227) or TTY: 1-877-486-2048, 7 days a week, 24 hours a day. If you need help in a language other than English or Spanish, say “Agent” to talk to a customer service representative. Or visit the Medicare website. 

Social Security Administration - For questions about Medicare eligibility, Social Security retirement benefits or help paying for prescription drugs. Call 1-800-772-1213 or TTY: 1-800-325-0778, Monday to Friday, 8 AM to 7 PM or visit the Social Security website.

Most health care professionals and organizations that provide Medicare services are honest. Unfortunately, there may be some who are not. If you ever suspect fraud, please contact Member Services at the number on the back of your ID card, or call Medicare toll-free at 1-800-MEDICARE (1-800-633-4227) or TTY: 1-877-486-2048, 7 days a week, 24 hours a day.

Let the HOP know if you have a new phone number or address. Call 1-800-773-7725 (TTY: 711), Monday to Friday, 8 AM to 8 PM ET, or visit www.hopbenefits.com.

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. 

Specifically, we: 
 

• Base our decisions on appropriateness of care, service and plan coverage 

• Use nationally recognized guidelines and resources to make changes 

• Don’t pay or reward providers, employees or others for denying coverage or care 

• Focus on reviewing the risks of members who aren’t fully using certain services
  

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:
 

• Carefully review the latest information and ask experts for their opinions

• Compare the information with well-known standards

• Base all of our decisions on making sure you have the right care and services
  

Your coverage for out-of-network providers depends on the type of plan you have.  

If you’re enrolled in an Aetna Medicare^SM  (PPO) plan

 
PPO plans have a network of doctors and hospitals for you to get care.  You can go out of the network for care but it usually costs you more.

 If you’re enrolled in an Aetna Medicare^SM HMO plan 

An HMO plan requires you to stay within your network of providers to receive coverage except in urgent or emergency situations.

See if your chosen provider or facility is part of the Aetna network 

Please call us or see your Evidence of Coverage for more information, including the cost share for out‐of‐network services.

The Centers for Medicare & Medicaid Services periodically issues National Coverage Determinations. They issue these when a service’s or drug’s coverage rules change. 

View a list of coverage determinations

What are some of the benefits of the HOP Aetna Medicare^SM Plan (PPO) - a Preferred Provider Organization?  
 

The HOP Aetna Medicare^SM Plan (PPO) offers comprehensive coverage, all in one plan, for new Medicare eligible retirees and dependents who reside in certain Pennsylvania counties (see a list of all counties) and some counties in Florida, Maryland, New Jersey and New York (see a list of counties). This plan covers a comprehensive array of services from annual wellness exams to preventive care and hospitalization. We also protect your health care dollars with predictable out-of-pocket plan limits and discounts on many health-related products and services.

What are some of the additional benefits of the Aetna Medicare (PPO) Plans? 

• Preventive care at no additional cost. 
  

• Freedom to use providers in and out of our nationwide network. (You may pay more when receiving services from out-of-network providers.) Out-of-network providers must be eligible to receive Medicare payment and willing to accept the plan. 

• Free health and wellness programs. 

• Assurance that in-network doctors go through a detailed Aetna credentialing review process.  

• Access to Aetna’s large network of doctors, hospitals and other health care providers. Search for a doctor or a provider to see a list of providers in our network or call 1-800-248-7227 (TTY: 711), 8 AM to 8 PM, 7 days a week. 

• Online tools and a 24-hour toll-free health information line to help you stay informed.  

• National Medical Excellence Program® — If approved for this program, you can gain access to our national network of respected doctors and facilities (for those with a complex illness such as solid organ or stem cell transplants).  

• Coverage for medical emergencies when traveling outside the United States. 

• Filling prescriptions at more than 60,000 network pharmacy locations all over the country or access Aetna Rx Home Delivery® .

What are some of the benefits of the HOP Aetna Medicare^SM Plan (HMO) - a Health Maintenance Organization? 

 
Existing Aetna members and dependents in Pennsylvania, Florida, Maryland, New Jersey, and New York may have the ability to stay in our HOP Aetna Medicare Plan (HMO) with Medicare Part D Prescription Drug coverage. You’ll enjoy a plan with limits on your out-of-pocket costs and low, predictable copayments.  
 

What are some of the additional benefits of the Aetna Medicare (HMO) Plans? 

• No deductible and coverage for preventative care at no additional cost. 

• Medical coverage whenever you travel to another Aetna Medicare Plan service area with Aetna’s U.S. Travel Advantage Program (however, you must enroll by calling Aetna before you travel). 

• The ability to change your Primary Care Provider at any time, for any reason. In fact, you can change your PCP online at your secure member website.  

• Access to Aetna's large, nationwide network of doctors, hospitals and other health care providers. Search for a doctor or a provider to see a list of providers in our network or call 1-800-248-7227 (TTY: 711), 8 AM to 8 PM, 7 days a week. 

• National Medical Excellence Program® — If approved for this program, you can gain access to our national network of respected doctors and facilities (for those with a complex illness such as solid organ or stem cell transplants).  

• Coverage for emergency medical treatments when traveling outside the United States.  

• Filling prescriptions at more than 60,000 network pharmacy locations all over the country or access Rx Home Delivery .

• You must use plan providers except in emergent or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Aetna Medicare will be responsible for the costs.