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Claims & Reimbursements

Print a prescription drug claim form

Print a prescription drug claim form (Spanish)

Medical Reimbursement Form

Medical Reimbursement Form (Spanish)

Give another person permission to help manage your care

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

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)

Prescription drugs

Medication Order Form for CVS Caremark® Mail Service Pharmacy

Medication Order Form for CVS Caremark® Mail Service Pharmacy (Spanish)

Medication Action Plan

Medication Action Plan (Spanish)

Personal Medication List

Personal Medication List (Spanish)

Member exceptions, appeals and grievances

Learn more about requesting an exception or filing a grievance or appeal:
Access forms and learn what steps to take

We're here to help!

Call us at 1-844-233-1939
(TTY: 711), Monday to Friday,
8 a.m. to 6 p.m., all time zones.
Or call Member Services at
the number on your ID card.

We speak your language: We have free interpreter services to answer questions you may have about our health or drug plan.
Get help from an interpreter

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Disclaimers

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. 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.

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Prescription Drugs

Live Well

Find the forms you need

Claims & Reimbursements

Give another person permission to help manage your care

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

Prescription drugs

Member exceptions, appeals and grievances

We're here to help!

We speak your language

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You are now leaving the Aetna Medicare website.

You are now leaving our Medicare website.

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