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The Aetna Better Health® difference
You deserve to be as healthy as you can be. That’s why we offer unique benefits that take care of the whole you. We have experience you can count on — with a range of services to help you on your health journey. We’ve added some benefits that go beyond your standard health coverage.
Pregnancy and newborn care
Are you planning to start a family or expecting a child? We’ll help you stay healthy during your pregnancy. Our programs can help you get the care and services you need.
Healthy behaviors and rewards
Did you know that you can get rewards for taking care of your health? Take part in one or more of our healthy behaviors programs, and you can earn gift cards and more. We’ll show you how it works.
$25 for over-the-counter (OTC) products
Members age 20 and older can get $25 per month toward some OTC medications and supplies. Just have your member ID number ready when you place your order.
Benefits in your plan
Benefits in your plan
Learn about all your plan benefits, from vision care and telehealth to pregnancy care and quitting nicotine use. You can learn more about all these topics in your member handbook English (PDF) | Spanish (PDF).
To manage your covered benefits, we:
Work with your doctor to decide what care you need
Decide what care is covered
We contract with a select network of providers. We check these doctors and hospitals often to make sure you get the care you need. There may be times when no network provider can give you the care you need. In this case, you can see an out-of-network provider if we approve it first.
Members don’t have any copays except for medications and hospice care. If a provider bills you, don’t pay the bill. Just call us at 1-800-441-5501 (TTY: 711).
Approval for services
Some services need approval, or prior authorization (PA), before you get them. We base all our decisions on whether the service is:
Needed for your health
Likely to help you
You can learn more about PA. Just visit our PA page.
We take care of the whole you. That means you’re covered if you need to see a specialist, have an emergency or plan to start a family. Preventive care and vaccines are covered. Unlimited visits to doctors in our network are also covered.
Are you homebound or not able to safely travel to your primary care provider’s (PCP’s) office? If yes, you can get one more PCP home visit and one more specialist home visit covered each month.
A healthy smile goes a long way. Dental care is part of your overall health. That’s why you should see your dentist every six months.
Your dental services are covered by the Statewide Medicaid Managed Care (SMMC) program, not by Aetna Better Health®. You can find coverage and provider details on the SMMC website. If you need additional information about the program, please contact a Choice Counselor at 1-877-711-3662.
Routine eye exams are an easy way to keep your eyes healthy. You don’t need a referral to see a provider in the network. Just be sure to show your member ID card at every visit.
Members age 21 years and older are covered for:
1 eye exam per year
6-month supply of contact lenses with prescription
1 extra glasses frame per year
You can find a vision provider with our provider search tool. Just search under "Find a specialty” for an optometrist or ophthalmologist.
We make it easy to get the medications you need to feel better. You may have a copay for those on the state’s preferred drug list (PDL). A PDL is a list of covered medications. If you don’t see your medication on the list, ask your provider to find one that’s similar. And you can fill your prescription at any pharmacy in our network.
You deserve to be healthy in body and mind. Your plan covers health for you as a whole person. That includes help with your mental health or substance use. You or your child can go to any behavioral health provider in our network.
Help in a crisis
Call 911 or go to the nearest hospital if:
- You have thoughts of harming yourself or someone else
- You have an emergency and need help right now
You can use any hospital for emergency care, even if it isn’t in our network. Just show your member ID card.
You can also call:
Us at 1-800-441-5501 (TTY: 711). Choose the crisis line option. We’re here for you 24 hours a day, 7 days a week.
We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. And you don’t need prior authorization. Any family planning care that you get is private.
Covered services include:
- Birth control medication and supplies
- Classes and educational info
- Diagnostic procedures
Stopping nicotine use is hard, whether you smoke, chew, vape or use another way. Most people need help to quit, and we’re here for you. You can join our tobacco cessation healthy behaviors program. You can earn rewards as part of the program. For example, you can earn a $20 gift card for reaching certain goals.
Do you need help getting care? Our care management team is here for you. You’ll get a case manager as part of our care management program. Case managers are nurses and social workers who understand your health conditions and help connect you to the right care. A case manager can help you learn more about your health, find a ride to your appointments and more.
Some health issues need more care. Our care managers can help you manage chronic complex conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.
If it’s late at night or you can’t reach your PCP, you’re not alone. You can speak with a nurse about your health care questions 24 hours a day, 7 days a week. Not sure if you should find urgent care or go to the emergency room? The Nurse Line can help. It doesn’t take the place of your PCP, so be sure to follow up later.
Just call Member Services. Then, choose the option for the Nurse Line.
You can get a smartphone with an Android™ platform and Assurance Wireless Lifeline cell service at no extra cost to you. If you already have Lifeline, you can switch to Assurance Wireless. You’ll get:
- A smartphone with an Android platform
- Data each month
- Unlimited texts
- Voice minutes each month
- Health tips and reminders by text
- One-on-one texting with your health care team
- Calls to Member Services that won’t count against your monthly minutes
If you can’t get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency for all members.
If you don’t have a ride to your appointment, we’ll help you get one. These rides are for the medical services we cover, like:
- Doctor visits
- Dental care
- Behavioral health care
You can contact Modivcare at 1-866-799-4463 (TTY: 1-866-288-3133) to schedule a ride. After hours, you can call the Ride Assist line at 1-866-799-4464 (TTY: 1-866-288-3133). Be sure to schedule rides at least one business day in advance.
Other language and format needs
Need language help? Just call us at 1-800-441-5501 (TTY: 711). We’re here for you Monday through Friday from 8 AM to 7 PM. You can get:
- Interpreter services at no cost during any service or complaint process, including American Sign Language and real-time oral interpretation
- Interpreter services for your medical visit (be sure to call 48 hours before your visit)
- Info in another format, like audio CD-ROM, large print and braille
- Materials in other languages if your primary language isn’t English
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