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What’s covered?

We provide Healthy Louisiana (Medicaid) coverage. You’ll get access to a wide range of benefits and services to help you reach your health goals. For complete info, see our list of covered services English (PDF) | Spanish (PDF)

The Aetna Better Health® difference

 

At Aetna Better Health of Louisiana, we help you live your healthiest life. That’s why we offer unique benefits that take care of the whole you — body, mind and spirit. We have experience you can count on — with a range of specialty services to help you reach your health goals.

Maternity Matters

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. And you can earn rewards for making healthy choices. 

$25 for over-the-counter (OTC) products

You can get $25 per month toward some OTC medications and supplies. And we’ll mail them directly to you. Just have your member ID number ready when you place your order. 

Telehealth

Through secure video on your computer, you can meet with a licensed doctor for treatment of common health conditions. Cold or flu? Great reasons to use telehealth. You can also get help with allergies, sinus problems and more.

Help stopping nicotine use

Get coaching and medications to help you quit. 

Even more benefits

  • Dental care: $1,000 per year toward dental care 
  • Vision care: One eye exam and $150 toward glasses (frames and lenses) or contact lenses every year
  • Rewards you can earn: Gift cards for completing certain healthy steps

Benefits in your plan

Benefits in your plan

Learn about all your plan benefits, from vision and dental care to telehealth, maternity care and help stopping nicotine use. 

 

Medicaid coverage

 

Medicaid covers some services that we don’t cover. For these services, you don’t have to use a provider in our network.

 

Copays

 

Members don’t have any copays. You don’t pay anything to get services we cover. You only have copays for medications. If a provider bills you, don’t pay the bill. Just call us.

 

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
  • Covered 

You can learn more about PA. Just check your member handbook. Or 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. You have unlimited visits, so you can see your primary care physician (PCP) as many times as you need to — at no cost.

 

You can also get a wide range of preventive care and vaccines. Start by finding a provider today. 

 

Find a provider

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 benefits cover $1,000 per year toward dental care for things like:

 

  • Exam, bitewing X-rays and cleanings (twice a year)
  • Fillings, extractions, restorative services and dentures (once a year) 

 

Adult dental benefits are for members ages 21 and over who don’t have other dental coverage. Kids get coverage through Managed Care of North America (MCNA) Dental. 

 

Learn more about dental care

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.

 

Learn more about vision care

We make it easy to get the medications you need to feel better. You may have a copay for those on our preferred drug list (PDL). This is a list of medications we cover. If you don’t see yours on the list, ask your provider to help you find one that’s similar. And you can fill your prescription at any pharmacy in our network. 

 

Learn more about pharmacy benefits

We want to help members manage pain in ways that are safe and effective. Talk with your doctor about pain medications other than opioids. You also have access to other ways to manage pain. We’ll cover up to:

 

  • $150 in acupuncture services 
  • Three chiropractic visits each year

 

 Questions about pain management? Just call us at 1-855-242-0802 (TTY: 711).

Your mental health is part of your overall health. So if you need help with mental health or a substance use disorder, we’re here for you. We offer behavioral health treatment to our members who need some extra care. We’ll also connect you with local resources for more support.

 

What to do if you’re having a crisis

 

If you’re thinking of hurting yourself or someone else, get help right away. You can call: 

 

Learn more about mental and behavioral health benefits

Maternity Matters is a program that helps you and your baby be as healthy as possible. Some benefits include:

 

  • A new mom welcome kit and baby bundle with diapers, diaper bag and other items
  • Info about healthy pregnancies and baby care 
  • Help from a care manager 
  • Text4baby™, a text service that sends health tips and reminders 
  • Local community programs and resources
  • Info about family planning 
  • Coverage of long-acting birth control
  • Coverage of circumcision for newborn boys

 

Learn more about pregnancy care

We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. Any family planning care that you get is private. You can call us at 1-855-242-0802 (TTY: 711) to choose a family planning provider. Or you can read more about family planning.

Smoking Cessation Trust

 

Did you smoke a cigarette before September 1, 1988? If yes, you can get help quitting through the Louisiana Smoking Cessation Trust. This program includes support and medication. 

 

What if you didn’t smoke before September 1, 1988? Just check with us. If you qualify, we’ll contract with the Trust to cover the same services. Program members can get:

 

  • Office visits and counseling with smoking cessation service providers
  • Unlimited toll-free calls to the 24/7 program quit line
  • Help from a quit coach, who creates a personal program for you
  • Online smoking cessation info and tools, as well as printed materials

 

Start to Stop program

 

This quit-smoking program includes:

 

  • A one-on-one consultation with a nurse, including a nicotine dependence assessment
  • A personal smoking cessation plan and education based on your needs and goals
  • Ongoing coaching and support to quit smoking

 

Members ages 18 and older can take part in one of these programs — the Trust or Start to Stop. If you’re under age 18, you can get started with written consent from your parent or guardian.

 

Questions on how to get started? You can call us at 1-855-242-0802 (TTY: 711).

Do you need help getting care? Our care management team is here for you. Care managers are nurses and social workers who understand your health conditions and help connect you to the right care. A care 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 conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.  

 

Learn more about care management

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.

 

You can reach the Nurse Line at 1-855-242-0802 (TTY: 711).

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 mothly minutes


Apply for your smartphone

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.  

 

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 and behavioral health care. You can contact One Call at 1-877-917-4150 (TTY: 1-866-288-3133) Monday through Friday, 8 AM to 5 PM. Be sure to schedule rides at least two business days in advance.

 

Learn more about rides

Respite care for the homeless

 

The Salvation Army will provide short-term residential care with wraparound medical respite services for members 18 years old and over. These services include:

 

  • Post-acute medical services
  • Counseling
  • Nutrition
  • Housing stabilization
  • Transitional care

Homeless members can live in a safe environment while they get the medical care they need. We’ll pay for up to 14 days of housing, respite and wraparound services. The Salvation Army has permanent supportive housing locations in Alexandria, Baton Rouge, Lafayette, Lake Charles, Monroe, New Orleans and Shreveport.

 

Home meal delivery

 

This benefit is for members who get supplementary security income (SSI) from the Social Security Administration. This includes members with limited income and resources who are:

 

  • Disabled
  • Blind
  • Ages 65 or older 

 

Children who are blind or disabled may also get SSI. Members can get two meals a day for up to 14 days after release from post-acute care.

 

 

Job skills training

 

Members ages 16 and older can take courses to ensure they have a good understanding of the workplace. You can develop skills in:

 

  • Problem solving
  • Communication
  • Professionalism

 

These courses can help you move forward with your career goals. You can also take your high school equivalency test (HiSET) and get certification. 

 

Need to learn more about these resources? You can call us 1-855-242-0802 (TTY: 711).

 

Special programs

 

These programs can help you live life as healthy as you can be. We have special programs and services to help you get the care you need. And prevent health issues in the future.

 

Learn more about special programs

Other language and format needs

 

We provide interpreter services free of charge during any service or grievance process. This includes American Sign Language and real-time oral interpretation. If you need something translated into a language other than English, just call us. We can also provide materials in other formats, too. Like braille, audio CD or large print. And if you need an interpreter for your medical visit, you can call us at 1-855-242-0802 (TTY: 711). Be sure to call 48 hours before your visit.

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