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Frequently asked questions

General questions

Medicaid is a program that provides health care for millions of Americans. In Kentucky, it’s called Kentucky Medicaid. It covers low-income adults, children, pregnant women, elderly adults and people with disabilities. If you qualify, you can get coverage for things like: 

 

  • Preventive care 

  • Vision 

  • Medications 

  • Chronic disease management 

  • Behavioral health services 

Learn more about what’s covered

 

Find out if you qualify

Before you can get coverage, be sure you qualify for Medicaid. 

 

You can also read the answers to the answers to 10 common questions about qualifying for Medicaid.

 

Learn more about how to enroll

Every 12 months, the state will see if you or your family members still qualify for Medicaid. The name for this review is redetermination. 

 

Learn more about how to renew your coverage

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.

 

Learn more about filing a grievance or an appeal

Tell us. You have the right to report anyone you believe is committing fraud or abusing the Medicaid system. You can use this form to report fraud or abuse

 

Learn more about fraud or abuse

Member Services

You’ll find your health plan summary and benefits info in your member handbook or on your secure Member Portal. 

 

Log in to the Member Portal

You can reach us Monday through Friday, 7 AM to 7 PM ET. Just call 1-855-300-5528 (TTY: 711) or log in to your secure Member Portal.

Just log in to your secure Member Portal to ask for a new card. Or call us at 1-855-300-5528 (TTY: 711) to get a new ID card.

My health care providers

You can change your PCP through your secure Member Portal. Or call the toll-free number on your ID card. Then, just follow the menu options. 

 

Log in to the Member Portal

Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal.

 

Log in to the Member Portal

Your PCP can refer you to a specialist in our network. Specialists are doctors who treat specific conditions.

 

Find a specialist near you

Call the provider’s office and let them know you have Aetna Better Health. If you keep getting bills, just call us at 1-855-300-5528 (TTY: 711).

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.

 

If it’s not an emergency but you need medical advice, call us at 1-855-620-3924 (TTY: 711). The nurse can help you decide if you need to go to the ER or urgent care.

 

Find the closest hospital

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 for all members. 

Pregnant women need special care. And they need to get it early. We can help with pregnancy care. Just call us as soon as you can at 1-855-300-5528 (TTY: 711)

 

You can also visit our health and wellness library to learn more about pregnancywomen’s health and other topics to help keep you healthy.

Pharmacy

A PDL/formulary is a list of medications that a health plan covers. These medications treat a variety of conditions. And we keep our PDL/formulary up to date.

We use a group of providers and pharmacists to choose these medications. First, they get input from many doctors. Then, they choose the best medications. Often, two medications are equally safe and effective. But their known benefits may be different. After a review, the group may add new medications to the list.

You can ask your provider to:

 

  • Give you a similar medication that is on the list

  • Get prior authorization (PA) to cover this medication

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. Not sure if a service needs PA? Just call us at 1-855-300-5528 (TTY: 711) to ask for the most current PA list. Before providing a service, your provider should check the list. It may change from time to time. 

We have quantity limits for different reasons. Some medications have a maximum limit or dose for safety reasons. Our clinical staff sets the limits. In some cases, we make exceptions. Have your doctor contact us. We’ll review the info your doctor provides and make a decision.

We don’t cover these types of medications on our PDL/formulary:

 

  • Cosmetic 

  • Hair growth

  • Infertility or erectile dysfunction 

  • Experimental or investigational 

You don’t need a referral to see in-network doctors 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. To ask for the current PA list, just call us at 1-855-300-5528 (TTY: 711).  

 

Are you enrolled in the Supportive Managed Care (formerly Lock-in) program? If yes, you’ll need a referral to see other doctors. Just ask your PCP to fax us a referral form (PDF) at 1-866-415-2818. You’ll want to do this before you see other doctors or specialists. We can’t cover your visit without the referral on file. And we won’t be able to cover any prescriptions or tests other providers may order.  

 

Just follow the directions on the referral form. And remember, this form is for the Supportive Managed Care program. You’ll still need a referral from your PCP to your specialist or other provider, if required.  

Mental health

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, child care 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 can be hard to eat healthy, exercise and follow all the other habits that are part of good self-care. 

 

Learn more about healthy habits: 

 

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 secure Member Portal

It may not be easy, but you can stop using tobacco — whether it’s smoking, vaping or chewing. Let’s quit together.

 

You can learn more about quitting from the:

 

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 secure Member Portal.

Learn more about substance use and mental health issues from the:

 

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 secure Member Portal.

 

And be sure to check out even more local resources and services. 

If you have thoughts of harming yourself or others, get help right away. Call the National Suicide Prevention Lifeline at  1-800-273-8255. You can also visit the Kentucky Suicide Prevention Group.  

 

And be sure to check out even more local resources and services.