Another group or vendor provides the info on the next page. If you don’t want to leave our site, choose the “X” in the upper right corner to close this message. Or choose “Go on” to move forward.
COVID-19
We know you have lots of questions about COVID-19. We’re here to support you with answers. Just check these resources to learn more:
General questions
Medicaid
Medicaid is a program that provides health care for millions of Americans. In Florida, regular Medicaid is called Managed Medical Assistance (MMA). It covers low-income adults, children, pregnant women, older people and people with disabilities. If you qualify, you can get coverage for things like:
Preventive care
Vision care
Dental care
Medications
Disease management
Mental and behavioral health
In addition to Medicaid MMA, Florida also offers Long-Term Care (LTC). This program offers long-term services and support for those who receive Medicaid and need a higher level of care. If eligible, you can get these services at home or in a nursing or other assisted living facility.
Florida Healthy Kids (FHK)
FHK is for children (ages 5 through 18) of from families who earn too much money to qualify for Medicaid. Those who qualify for FHK can get coverage for as low as $15 or $20 per month. You can get coverage for things like:
Preventive care
Vision care
Medications
Disease management
Mental and behavioral health
Rides to see a specialist or dentist
You can learn more about what’s covered for each plan:
Before you can get coverage, be sure you qualify for Medicaid or Florida Healthy Kids (FHK).
After you qualify for Medicaid or Florida Healthy Kids, you can choose Aetna Better Health as your health plan.
Yes, you must renew your Medicaid or FHK coverage every 12 months. You can find out how to do it by visiting our renewal page. Just click on “Learn about renewing your coverage” to go on.
We want you to be happy with the care you get. So if you’re ever unhappy with your health plan or a provider, you can file a grievance. Or you can file an appeal if we deny, delay or change a service. If you don’t agree with the decision on your appeal, you can ask for a state fair hearing or external review.
Medicaid enrollees: Use the state fair hearing process.
FHK enrollees: Use the external review process through an independent review organization (IRO).
Tell us. You have the right to report anyone you believe is committing fraud or abuse.
Member Services
You’ll find your health plan summary and benefits info in your member handbook or on your Member Portal or Aetna Better Health app.
We’re here to help. Just call us:
- Medicaid MMA: 1-800-441-5501 (TTY: 711), Monday through Friday, 8 AM to 7 PM ET
- Florida Healthy Kids (FHK): 1-844-528-5815 (TTY: 711), Monday through Friday, 7:30 AM to 7:30 PM ET
- Long-Term Care (LTC): 1-844-645-7371 (TTY: 711), Monday through Friday, 8 AM to 7 PM ET
You can also use the contact us page to get in touch. Or log in to your Member Portal or Aetna Better Health app.
You have some options if you lose your member ID card. First, log in to your Member Portal or Aetna Better Health app. There, you can:
- Ask us to mail you a new ID card
- Find the electronic version of your ID card — as long as you have your smartphone, you’ll always have your ID card with you for health care visits
Or just contact us.
Make sure to report any changes to your contact info. This allows you to keep the coverage you already have.
My health care providers
Your PCP is a medical provider who will manage your health care. They’re the doctor, nurse, physician assistant or clinic that provides your main health care. They’ll help you get all the covered services you need.
You can change your PCP through your Member Portal or Aetna Better Health app. You can also contact us by calling Member Services. This is the number on your Aetna® member ID card.
You can also learn more about choosing a PCP.
Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.
Specialists are providers who treat specific conditions. Your PCP might refer you to a specialist in our network. Or they may recommend you see one. Need help finding a specialist? Just contact us.
Call the provider’s office and let them know you have Aetna Better Health. This means you shouldn’t get a bill. If you keep getting bills, just contact us.
Here are some tips to keep in mind when it comes to bills:
- Always use a provider in the Aetna Better Health network.
- Carry your Aetna Better Health member ID card with you everywhere.
- You may have to pay for bills from providers who are not in-network with Aetna Better Health.
- Be sure to show the provider or facility your ID card when you arrive or before you leave.
- A wrong spelling can cause the doctor’s bill to be rejected, so make sure the name on your ID card matches what your provider has on file.
Coverage and care
Whether it’s day or night, your PCP or on-call provider can tell you what to do. If they’re not in the office, leave a message. They’ll return your call. Your provider must see you within 24 hours if you need urgent care.
If you're having an emergency, call 911 or go to the closest hospital.
You’ll only need emergency care if you think your health is in serious danger. Emergencies may include:
- Severe pain
- Serious injury
- Sudden illness
- Illness that is quickly getting much worse
- Heavy bleeding that doesn’t stop, especially if you’re pregnant
If it’s not an emergency, but you need medical advice, call Member Services. Then, choose the option for the 24-Hour Nurse Line. A nurse can help you decide if you need to go to the ER or urgent care.
Check out some of these articles to learn more about getting the right care at the right time:
If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency.
Nonemergency medical rides (Medicaid MMA and LTC members)
Need a ride to your doctor visits? If you’re a Medicaid MMA or LTC member, you can get help with rides to medical services we cover. We cover rides for your nonemergency medical needs. You can get a ride for visits to your:
- Health care provider
- Dental or vision provider
- Mental or behavioral health care provider
- Pharmacy
If you’re away from home and have an emergency, go to the closest hospital or call 911. The hospital doesn’t have to be in our network for coverage and care.
You can use the provider search tool to find an in-network hospital that’s covered. Or you can contact us for help.
Pregnant women need special care. You’ll want to see a provider within three weeks of a positive pregnancy test (home or lab). We can help with pregnancy care. Just contact us as soon as you can.
You can also visit our health and wellness library to learn more about pregnancy, women’s health and other topics to help keep you healthy.
You’ll want to make sure your baby has medical coverage. If you don’t have insurance when your baby is born, apply for Medicaid. You can do so by contacting the Department of Children and Families (DCF). Just call 1-866-762-2237.
If you have questions or need help, just contact us.
When you have a condition, you’ll work with your health care provider to set up a treatment plan. The plan will likely include certain steps, like:
- Taking medication
- Making lifestyle changes, like eating and exercising
- Finding emotional support
Some conditions can benefit from disease management, like:
- Asthma
- Chronic obstructive pulmonary disease (COPD)
- Coronary artery disease (CAD)
- Diabetes
- Heart failure
- Hepatitis C
- HIV
- Depression
- End-of-life health issues
Do you have one of these conditions? If yes, you may be able to get help from a care manager. You can learn more on our page about disease management. Or just contact us.
Dental benefits
Medicaid MMA and LTC: Dental services are covered by the Statewide Medicaid Managed Care (SMMC), not by Aetna Better Health. Visit the SMMC website to learn more about dental plan benefits and contact info.
Florida Healthy Kids (FHK): Dental services are covered by a separate dental company, not by Aetna Better Health. For more info on what’s covered, visit the Florida Healthy Kids website. Or call the Florida Healthy Kids Corporation at 1-888-540-KIDS (5437). You can call Monday through Friday, 7:30 AM to 7:30 PM ET.
Vision benefits
You can check your plan’s benefits info to learn more about vision benefits.
Florida Healthy Kids (FHK) benefits
Medicaid program members
Florida’s Agency for Healthcare Administration (AHCA) decides which benefits to cover under the Florida Medicaid program. Decisions are based on scientific evidence of safety and effectiveness. Aetna Better Health of Florida covers all items, services and drugs that AHCA decides to include as covered benefits.
Florida Healthy Kids (FHK) members
Doctors and health care companies are creating new technologies. This can be anything from a new test to a new machine. We have processes on how to look for and judge new devices. When we find out about new devices, we look over the new info and ask experts for their input. We match the info with known standards and base our decisions on making sure you have the right care.
Pharmacy
A PDL is a list of covered medications. The list may come from your state or health plan. These medications treat a variety of conditions. You can learn more on our pharmacy benefits page.
You can ask your provider to:
- Give you a similar medication that is preferred on the list
- Get prior authorization (PA) to cover this medication if they think it’s necessary to treat your medical condition
First, your provider will contact us. Then, our pharmacy staff will review the info your provider gave us. Finally, we’ll make a decision.
Some health care services and supplies need approval before you can get them. We follow nationally recognized guidelines to make these decisions. Before providing a service, your provider must check the list. It may change from time to time. You can learn more about PA.
You don’t need a referral to see in-network providers for routine and preventive health care services.
You do need PA for some health care services and supplies before you get them. We use nationally recognized guidelines to make PA decisions about care your provider suggests.
Your provider must check to see if your service requires PA before they provide it. You can learn more about PA.
We work with the state to set quantity limits for different reasons. Some medications have a maximum limit or dose for safety reasons. Our clinical staff sets the limits based on proven standards of care, such as the U.S. Food and Drug Administration (FDA) guidelines. In some cases, we make exceptions. Have your provider contact us. We’ll review the info from your provider and make a decision. You can learn more about pharmacy benefits.
These types of medications aren’t covered on the PDL:
Cosmetic
Hair growth
Infertility or erectile dysfunction
Experimental or investigational
You can learn more on our formulary and updates page.
The Agency for Health Care Administration (AHCA) works with a group of doctors and pharmacists to help make these decisions. This group is known as the Pharmacy and Therapeutics (P & T) Committee. First, the AHCA gets input from many doctors. Then, together, we choose the right medications for the PDL. Often, two medications are equally safe and effective. They can have differences in their known benefits.
After a review, the P & T committee may add medications to the list. New medications may be added as well as removed every year. Certain medications may be removed due to:
Changes in drug therapies
A new, generic option of a medication being released
Concerns about safety or effectiveness
Some medications are a benefit exclusion under the Medicaid benefit policy.
Doctors try to choose medications on the preferred drug list (PDL). Sometimes they’ll choose medications not on the PDL. Your doctor may have forgotten which medications are on your plan list.
Oftentimes, doctors may choose new or other medications because:
- They met with a drug company representative
- They saw an advertisement
- They’ve used the medication in the past (even though other ones are on the list)
We make sure that the right medications are on the PDL. You can learn more on our pharmacy benefits page.
You can only get specialty medication through a pharmacy that’s in the specialty network. Other pharmacies will not be able to dispense the medication and the claim will be rejected.
No. Generally, the specialty pharmacies only support specialty medication for certain diseases. They don’t usually stock other traditional medications.
Call CVS Specialty pharmacy at 1-800-237-2767 (TTY/TDD: 1-800-863-5488) Monday through Friday, 7:30 AM to 9:00 PM. They can help replace your medication or get you the right one.
Your health
Staying active is one of the best things you can do for your health. It can:
- Give you more energy
- Help you feel better
- Prevent some health problems that go along with aging
Some physical activity is better than none at all. But check with your doctor before you start — just to be sure it’s safe. Want to learn more about staying active?
You can learn more about health goals, info and coaching.
You’re not alone. During the COVID-19 pandemic, many people have felt more stress and anxiety than ever. They need more help than usual coping with everyday pressures. Things like job loss, childcare issues and other challenges are very real.
Did you know that stress can affect your health? It’s common during times of stress to pick up some unhealthy habits. Don’t be too hard on yourself. It’s not always easy, but you can learn ways to:
- Eat healthy
- Exercise regularly
- Start other healthy habits
Learn more about healthy habits:
- Healthy living resources
- 4 ways to take care of physical and mental well-being during unsettled times
- Staying mentally healthy in tough times
Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. Or you can find this info on your Member Portal or Aetna Better Health app.
It may not be easy, but you can stop using nicotine — whether it’s smoking, vaping, chewing or another form. Let’s quit together.
Find more support
You can also learn more about quitting from the:
- American Cancer Society’s guide to quitting smoking
- Great American Smokeout® event
- Centers for Disease Control and Prevention at 1-800-QUIT-NOW (1-800-784-8669)
Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.
Learn more about substance use and mental health issues from the:
- Alcoholics Anonymous® website
- Substance Abuse and Mental Health Services Administration (SAMHSA) website
And be sure to check out even more mental and behavioral health resources.
Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.
If you have thoughts of harming yourself or others, get help right away. Call The National Suicide Prevention Lifeline at 1-800-273-8255 (TTY: 711).
And be sure to check out even more mental and behavioral health resources.
The Great American Smokeout is a registered trademark of the American Cancer Society, Inc.
Alcoholics Anonymous is a registered trademark of Alcoholics Anonymous World Services, Inc.