Benefit summary
Aetna Better Health gives you access to services like doctor’s visits, lab testing, X-rays and much more. These benefits and programs are designed to help you live a healthier life. This coverage includes preventive care and help for serious health concerns. These may be chronic diseases or mental health issues. We also can connect you with resources in your community for extra help.
Look at this section closely. It will help you understand what is covered by your plan, what is not and how you can find the right care when you need it.
Some limitations and prior authorization requirements may apply. All services must be medically necessary*. If you have questions about covered services, call Member Services at 1-866-212-2851.
Services
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Covered services
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Type of care
Abortions
Ambulatory surgery
Behavioral health
Chiropractic
Dental
Dialysis — outpatient
Medical equipment and supplies
Emergency room
Emergency transportation
Eye care
Family planning
Hearing care
Home health care
Hospice services
Hospital - inpatient
Immunizations (shots)
Laboratory services/x-rays
Nurse midwife services
Maternity care
Nursing care
Organ transplant
Orthotics/prosthetics
PCP visit
Podiatric services
Provider office visits/preventive care
Rehabilitative services
Radiology
Covered services
- Preoperative examinations
- Operating and recovery room services
- All required drugs and medicine
Mental health services including but not limited to:
- Mental health assessment and/or psychological evaluation
- Medication management
- Community treatment and support including peer specialists or family peer specialist support services
- Therapy/counseling
Sub-acute alcohol and substance abuse treatment, including but not limited to:
- Outpatient treatment
- Residential treatment
- Detoxification
- Psychiatric evaluation services
- Day treatment
Services are limited to the treatment of the spine by manual manipulation.
- Exams (1 per year for members)
- Cleanings (2 per year per member)
- X-rays
- Fillings
- Extractions (pulling)
- Fluoride treatments (1 per year)
- Sealants
- Crowns (caps)
- Root canals
- Dentures
- "Practice" visits for members to become more comfortable with the dentist's office
- Mobile dental services for members in intermediate care facilities and nursing homes
Nondurable medical supplies, including, but not limited to:
- Asthma medical supplies such as peak flow meter (not including medicine)
- Diabetes testing supplies such as glucometer (not including medicine)
- Durable medical supplies (DME) including but not limited to:
- Wheelchairs
- Oxygen supplies
- Apnea monitors
- Routine eye exam (1 per year)
- Glasses (1 pair every 2 years for adults, 1 pair per year for members age under 21)
- Medically necessary contacts
- Replacement glasses for members ages 19 and 20 as needed. This includes lenses and frames
- Replacement lenses for members ages 21 and older, when medically necessary
- One replacement pair of glasses each year if the first pair of glasses is lost or broken beyond repair, for members ages 21 and older
Including but not limited to:
- Provider visit
- Birth control and family planning education and counseling
- Contraceptives (birth control)
- Testing for sexually transmitted diseases and HIV
- Sterilization
Includes:
- Audiologist services
- Hearing screening
- Cochlear implants
- Hearing aids and repairs
- Prenatal care (before birth)
- Labor and delivery
- Postpartum (after the baby is born)
Members under the age of 21 can get medically necessary in-home shift nursing and personal care services provided by a registered nurse (RN), licensed practical nurse (LPN) or Certified Nurse’s Aide under the direction of a qualified home health agency.
Includes:
- Periodic well adolescent visits (members 19-20)
- Well woman visits
- Well man visits
Including but not limited to:
- Occupational therapy
- Physical therapy
- Speech and language therapy
Coverage and benefit limitations
Covered benefit when necessary to preserve the woman's life or health or when the pregnancy is the result of rape or incest.
Covered benefit
Covered benefit
Covered benefit
Covered benefit for adult emergency dental care. Call DentaQuest toll free at
1-800-416-9185 for more information.Covered benefit
Covered benefit
Provider must get authorization for these services.
The member must use a medical supply company or pharmacy that is in our network.
Covered benefit
Covered benefit
Covered benefit
Call March Vision Care toll free at 1-888-493-4070 for more information.
Limitations on exams:
1 per year
Limitations on glasses:
1 every 2 years
Covered benefit
Limitations on sterilization include:
Age 21 or older
Completed consent form
Covered benefit
Covered benefit
Benefits will be limited to Medicare coverage and benefit limitations
Covered benefit
Covered benefit
Covered benefit
Covered benefit
Covered benefit
Covered benefit for members ages 19- 20 who are not in the Medically Fragile Technology Dependent (MFTD) waiver.
Home health agency providing the nursing services must be in our network.
Covered benefit
Covered benefit
Covered benefit
Covered benefit for adults with diabetes, only.
Covered benefit
Covered benefit for adults; limited to an annual maximum of 20 services per discipline per year.
Covered benefit
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Non-covered services
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The following services are not covered:
- Services available without charge
- Services prohibited by state or federal law
- Experimental procedures
- Research-oriented procedure
- Medical examinations required for entrance into adult educational or vocational programs
- Autopsy examinations
- Artificial insemination
- Medical or surgical procedures performed for cosmetic purposes
- Medical or surgical transsexual treatment services
- Diagnostic or therapeutic procedures related to secondary infertility/sterility
- Acupuncture
- Medical care provided by mail or telephone, except for approved telemedicine services. (Note: this does not prohibit the mailing of medically necessary covered items; for example, prescription drugs sent to a patient by a mail-order pharmacy)
- Services provided by terminated or barred providers
- Visits with persons other than a patient, such as family members or long term care facility staff
- Items or services for which medical necessity is not clearly established
- Services provided only, or primarily, for the convenience of patients or their families
- Services from a provider that is NOT in our network (unless approved by Aetna Better Health first)
- Cosmetic services or items
- Any service not prior authorized that needs prior authorization
- Services or items given free of charge, or for which charges are not usually made
- Services that are determined to be experimental by the health plan medical director
- Sex change operations and reversal of voluntary sterilization
- Medications and supplies without a prescription
Benefits
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Dental
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Dental benefits
Dental services are provided by DentaQuest's providers. Please call Member Services at 1-866-212-2851 for more information. Find a dentist.You may choose any general dentist from the list. If you need to change, just choose a new dentist from the same list.
See the list below for a list of covered dental services. Call DentaQuest toll free at 1-800-416-9185 for more information.
- Exams
- Cleanings (2 per year, per member)
- X-rays
- Fillings
- Extractions (pulling)
- Fluoride treatments
- Sealants
- Crowns (caps)
- Root canals
- Dentures
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Vision
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Vision benefits
March Vision Care provides your eye care benefits. To see an eye doctor in the network, you do not need a referral. Providers are family eye doctors, retail chains and even mall spots with evening and weekend hours. Please note that this search displays all providers. You eligible to visit only providers who have Medicaid listed under the provider name column.Your covered services include:
- One routine eye exam each year.
- One pair of glasses each year every two years for adults, one pair of glasses every year for members under age 21.
- Medically necessary contact lenses.
- Replacement glasses for members ages 19 and 20 as needed. This includes lenses and frames.
- Replacement lenses for members ages 21 and older, when medically necessary.
- One replacement pair of glasses each year if the first pair of glasses is lost or broken beyond repair, for members ages 21 and older.
If you have questions about eye care, call March Vision Care at 1-888-493-4070. Find a March Vision provider.
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Transportation
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Transportation
If you have a medical emergency, dial 911.
Use of emergency transportation must be for emergencies only.
Non-emergency transportation
If you need a ride to your health care visits or to the pharmacy to pick up your prescription, call 1-866-212-2851 to set up transportation.
You can call to schedule a ride Monday - Saturday from 8 a.m. - 6 p.m. Central time. Please set up a ride at least three days before your appointment.
Mileage reimbursement is available if you use your own car or get a ride from someone. You have seven days after your appointment to ask for mileage reimbursement. Call Member Services at 1-866-212-2851 and they will help you do this.
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SafeLink
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Free cell phones for Aetna Better Health members- Help our members access a phone:
Improving member health the mobile way
A free cell phone with 350 free minutes per month and unlimited text messages can make a big difference to anyone struggling to make ends meet. Text messaging has been found to be an effective method in improving health outcomes. That’s why we’re very excited to share this information with Aetna Better Health of Illinois staff.
Getting the word out
We’re currently notifying our Medical Assistance* members that they can get a cell phone, free minutes and unlimited texting through SafeLink Wireless. You can help spread the word when you’re interacting with our members.
Member households that enroll in the program receive a cell phone at no cost. Members can also receive text messages to encourage healthy behaviors. Members who already have a government phone may enroll in our text4health programs.
How it works
Eligible members can receive a free SafeLink cell phone with:
- A free cell phone
- 350 free minutes a month
- Free unlimited text messaging
- Free calls to Aetna Better Health of Illinois member services
Definition of medically necessary
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*Definition of medically necessary
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Aetna Better Health considers a service, supply or medicine to be medically necessary when it meets the descriptions below:
- It is appropriate
- It is considered by other health professionals to be good medical practice
- It meets Aetna Better Health's guidelines, policies and procedures
- It is used to diagnose or treat a covered illness or injury
- It is used to prevent an illness
- It is used to help you get well or stay well