Medicare plans have many different details and forms, so we’ve organized everything together into one convenient place.
Plan benefits and forms
Your Aetna plan benefits and forms
Knowing more about your plan can help you get the most from your benefits and covered services. Find your plan’s Summary of Benefits and other coverage details below. Your member ID card shows your plan’s name. See a word or term you don't know? Check our glossary.
CHOOSE YOUR PLAN YEAR:
2024
Review your Evidence of Coverage to learn about comprehensive plan details, and your rights and responsibilities.
View, download, or request a copy of your Annual Notice of Change or Evidence of Coverage.
Find Medicare forms
See below for helpful resources for managing your plan and how to get started with common requests.
File claims and reimbursement requests
Printer-free reimbursement instructions - English (PDF) | Español (PDF)
Give someone permission to manage your care
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 and Medicaid Services (CMS) website if you link to the form.
Appointment of Representative CMS Form - English (PDF) | Español (PDF)
Exceptions, appeals and grievances
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.
Additional information
Find these documents online on your secure member website, sometimes you may need a printed version.
View, download, or request a printed Annual Notice of Change (ANOC) or Evidence of Coverage (EOC)
Medicare Helpline And 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 1-877-486-2048, 7 days a week, 24 hours a day.
If you’re moving or getting a new phone number, contact the EIX Benefits Connection at 1-866-693-4947, Monday to Friday, 7:30 a.m. to 5:30 p.m. PT, excluding holidays.
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:
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Base our decisions on appropriateness of care, service and plan coverage
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Use nationally recognized guidelines and resources to make changes
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Don’t pay or reward providers, employees or others for denying coverage or care
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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:
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Carefully review the latest information and ask experts for their opinions
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Compare the information with well-known standards
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Base all of our decisions on making sure you have the right care and services
2024 plan year
You’re being automatically enrolled into an Aetna Medicare℠ Advantage PPO ESA or HMO plan depending on your current plan design. However, you can switch to another Edison plan during the open enrollment period.
A PPO is a preferred provider organization plan. The Aetna Medicare Advantage PPO ESA plan is different than many other PPO plans.
It allows you to see any provider (whether in the network or not), and you pay the same out-of-pocket cost for both covered in-network and out-of-network medical benefits, as long as the provider is:
- Eligible to receive payment under Medicare
- Willing to bill and accept payment from Aetna
Your other Aetna Medicare Advantage plan option is an HMO, which is a health maintenance organization plan. You’ll have to use network providers for covered services. And it covers emergencies and out-of-area urgent care — even out of network.
The Centers for Medicare and Medicaid Services periodically issues National Coverage Determinations. They issue these when a service’s or drug’s coverage rules change.