Have Medicare coverage from an Employer or Group Sponsor?
Get the most value from your plan
The following tools and references can help you manage your Medicare plan. Since retiree plans vary, it’s important to review the information from your former employer, group sponsor or us.
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Manage your prescription drugs
Our prescription drug list (formulary) shows:
- The drugs we cover
- The tier a drug is on
- Any limits or requirements before we cover the drug
- Mail order availability
Refer to your plan documents to find out which formulary your prescription drug plan uses. You'll need to know the formulary name and the number of tiers. You have two options to find this information:
- Already an Aetna member? Look in your Schedule of Cost Sharing.
- Haven’t enrolled yet? Review the Plan Benefit Summary.
For 2018
For 2018
For 2017
For 2017
Find a doctor, pharmacy or other provider
Some members may have access to an Extended Service Area (ESA), giving them the freedom to use providers in and out-of-network. If a provider is not part of the Aetna Medicare network, ESA members can continue to see them as long as they are licensed, eligible to receive Medicare payment and agree to accept the ESA plan. If ESA members do not live in an Aetna network service area, they can view general provider information for their area by visiting www.medicare.gov.
Star Ratings
Find Medicare Star Ratings for your plan
If you're enrolled in the Aetna Medicare PPO plan, or PPO plan with ESA, your plan is rated 4.0 out of five (5) overall stars or higher! If you're a member of our HMO plan, you can find Star Ratings for your plan below.
For 2018
Select your location to see 2018 Star Ratings:
*Other drug references
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Changes to the drug list (formulary)
We review our drug list on a monthly basis and make changes as necessary. Most changes are positive. An example would be adding new generics that have come on the market.
Sometimes we have to make a negative change to our formulary. Like if the FDA views a drug as unsafe or the drug maker removes the drug from the market.
Prior authorization, quantity limits & step therapy
Some drugs have rules you need to follow before we cover them. These include:
- Prior authorization
You or your doctor need approval from us before we cover the drug. - Step therapy
We require you to try another drug first before we cover your drug. - Quantity limits
For certain drugs, we limit the amount you can get.
You and your doctor can ask us to make an exception to one of our coverage rules. This includes requesting an exception to a prior authorization, step therapy or quantity limit rule.
Transition rules
There may be times where you’re taking a drug that either isn’t on our drug list or has special rules before we cover it. Learn about our transition process to see if you’re eligible for a short-term supply of medication. This temporary supply allows you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.
We're here to help
Email us or call Member Services at the number on your ID card.
Don’t have your ID card handy?
Find a phone number-
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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Y0001_4006_10829 Approved 10/27/2017
Page last updated: Tue Jan 28 18:26:02 UTC 2020