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A: Medicaid is a government program that provides health care for millions of Americans. In Maryland, it’s called Maryland HealthChoice. It covers low-income adults, children, pregnant women, elderly adults and people with disabilities. If you qualify, you’ll be covered for a wide variety of benefits and services, including:
Chronic disease management
Behavioral health services
A: Every 12 months, the Maryland Department of Health will determine if you or your family members still qualify for Maryland HealthChoice. This review process is called redetermination.
A: We always try to give you the best health care experience possible. You’re encouraged to file a grievance if you’re unhappy with the service you got from us or one of our providers.
You can file an appeal if we deny, delay or change a service. If you don’t agree with the decision of your appeal, you can ask for a state fair hearing.
A: If you get a bill, call the provider’s office and let them know you have Aetna Better Health of Maryland. Please call Member Services if you keep getting bills. Their phone number is 1-866-827-2710 (TTY: 711).
Coverage and benefits
A: Whether it’s day or night, your PCP or on-call provider will be able to tell you what to do. If they’re not in the office, leave a message, and the PCP will return your call. Your provider must give you an appointment within 24 hours if you need urgent care.
A: If you think you need to go to the ER when your PCP isn’t available:
Call Member Services at 1-866-827-2710 (TTY: 711) and choose the option for our 24-Hour Nurse Line. The nurse can help you decide if you need to go to the ER or to urgent care.
Call 911 or go to the closest hospital if you’re having an emergency.
A: If you have an emergency and have no way to get to the hospital, call 911 for an ambulance. Aetna Better Health covers ambulance rides on the ground in a medical emergency for all members.
A: A formulary (drug list) is a list of drugs that a health plan covers. These drugs treat a variety of illnesses. We keep up-to-date on changes in drugs.
A: Aetna Better Health of Maryland uses a group of providers and pharmacists (P&T committee) to make these choices. First, they get input from many doctors. Then, they choose the best medicines. Often, two medicines are equally safe and effective. There can be differences in their known benefits. After a review, the committee may add new medicines to the list. Some medicines are not added because of a Medicaid benefit policy.
A: If your medication isn’t on our formulary, you can:
Ask your provider for a similar medication that is on the list
Ask your provider to get preapproval from Aetna Better Health of Maryland to cover this medicine
A: Your provider will contact us. Then, our pharmacy staff will review the information that your PCP gave us and make a decision.
A: Some medications need preapproval because doctors feel they should only be used after other medications have been tried first.
A: Quantity limits are set for different reasons. Limits are set because some medications have a maximum limit or a maximum dose for safety reasons. The limits are set after being reviewed by clinical staff.
We do make exceptions in some cases. Have your doctor contact our pharmacy staff. They will review the information provided by your doctor and make a decision.
A: The following medications are not covered under the formulary:
Medications for cosmetic use
Hair growth agents
Drugs to treat infertility or erectile dysfunction
Experimental or investigational medications