PDP plans are stand-alone prescription drug plans that offer only prescription drug coverage. You can add this type of plan to original Medicare and some types of Medicare Advantage plans that do not cover prescription drugs. MAPD plans are health maintenance organizations (HMOs), preferred provider organizations (PPOs), or private fee for service plans (PFFS). You generally can get all of your Medicare health care and prescription drugs through one plan with a MAPD plan. You may also see these plans referred to as Medicare Health Plans or Medicare Part C. If you join a Medicare Advantage or MA plan, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), private fee for service plans (PFFS) or Medicare Special Needs Plans To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer. Medigap plans are health insurance sold by private insurance companies to fill the "gaps" in Original Medicare Plan coverage. Medigap policies help pay some of the health care costs that the Original Medicare Plan doesn't cover. Generally, when you buy a Medigap policy you must have Medicare Part A and Part B. You will have to pay the monthly Medicare Part B premium ($99.90 in 2012 for most beneficiaries). In addition, you will have to pay a premium to the Medigap insurance company. As long as you pay your premium, your Medigap policy is guaranteed renewable. This means it is automatically renewed each year. Your coverage will continue year after year as long as you pay your premium. Please note that our cost information is an estimate. Your actual annual cost may vary depending on circumstances such as any applicable discounts or rebates, your choice of pharmacy or medications, or changes to your plan's benefit structure during the year.
Coventry Disclaimers Our dual-eligible Special Needs Plans (DSNPs) are available in Florida and Pennsylvania to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details.
You can reach First Health Part D customer service at 1-844-233-1938(TTY: 711) or Coventry Health Care customer service for Medicare Advantage plans at 1-844-741-8423(TTY: 711), 8 a.m. to 8 p.m., local time, seven days, from October 1 - February 14; 8 a.m. to 8 p.m., local time, Monday - Friday, from February 15 - September 30.
Aetna Disclaimers Aetna Medicare covers both brand name and generic prescription drugs. Generic drugs have the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Pharmacy clinical programs such as prior authorization, step therapy, and quantity limits may apply to your prescription drug coverage.
This is not a complete list of all formulary alternatives covered by the Part D sponsor for the drug you have selected. Our Medicare plans may not cover all of the drugs listed in this search tool. Also, the tool doesn’t include every drug that may be covered by Medicare.
General 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.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
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.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members where DSNP plans are available.
For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. Please call us if you do not receive your mail-order drugs within this timeframe.
Aetna and Coventry members please call the phone number listed on your member ID card.
Members may have the option to sign-up for automated mail-order delivery.
This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult http://www.medicare.gov.
Medicare beneficiaries may also enroll in an Aetna Medicare plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
Members who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays.
Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Aetna Medicare’s pharmacy network offers limited access to pharmacies with preferred cost sharing in: Suburban NY; and Rural AR, NY, and UT. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at http://www.aetnamedicare.com/pharmacyhelp.
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.