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
Each year, Medicare rates health and prescription drug plans on a Five–Star Quality Rating System. The Star ratings measure Medicare Advantage plans based on five areas:
- Staying healthy
- Managing chronic (long-term) conditions
- Member experience with the health plan
- Member complaints
- Health plan customer service
Our Medicare Advantage Prescription Drug (MAPD) plans have received high ratings by the Centers for Medicare and Medicaid Services (CMS) in the annual Star Ratings, released on October 11, 2019. For 2020, we have an overall weighted average of 4.3 out of 5.0 stars. We’re proud that the majority of our Medicare members are in a plan that’s rated 4.5 stars or higher.*
*Overall weighted average includes current enrollment of Aetna Medicare individual and group members enrolled in a Medicare Advantage plan. The overall rating for an MA-PD plan is calculated using a weighted average of the Part C and Part D measure stars. A total of 43 distinct measures are used in the calculation of the overall rating.
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.
Let us help you.
Call us at 1-800-307-4830 (TTY: 711), Monday to Friday, 8 AM to 6 PM ET.
Y0001_4006_10829 Approved 10/27/2017
Page last updated: Tue Jan 28 18:26:02 UTC 2020