As a Healthy Michigan member, you get benefits to help you be healthier.
Limitations, restrictions and patient pay amounts may apply. This means that you may have to pay for some services and that you need to follow certain rules to have Aetna Better Health pay for your services. For more information, call Aetna Better Health or read the Aetna Better Health Member Handbook.
Benefits, List of Covered Drugs, and pharmacy and provider networks may change from time to time throughout the year and on January 1 of each year. Please contact the plan for more details.
Covered Benefits and Services
We provide a full range of covered services. They include the following:
- Ambulance and other emergency medical transportation
- Breast pumps; personal use, double-electric
- Blood lead testing in accordance with Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) policy
- Certified nurse midwife services
- Certified pediatric and family nurse practitioner services
- Chiropractic services
- Dental benefits
- Diagnostic laboratory, x-ray and other imaging services
- Durable medical equipment (DME) and supplies including those that may be supplied by a pharmacy
- Emergency services
- End Stage Renal Disease (ESRD) services
- Family planning services (e.g., examination, sterilization procedures, limited infertility screening, and diagnosis)
- Health education
- Hearing and speech services
- *Hearing aids
- Home Health services
- Hospice services (if requested by the Enrollee)
- Inpatient and outpatient hospital services
- Intermittent or short-term restorative or rehabilitative services, in a nursing facility, up to 45 days
- Maternal and Infant Health Program (MIHP) services (effective Oct 1, 2016)
- Medically necessary weight reduction services
- Mental/Behavioral health services
- Non-emergent medical transportation (NEMT) to medically-necessary, covered services
- Out-of-state services authorized by the Contractor
- Parenting and birthing classes
- Pharmacy services
- Podiatry services
- Practitioners' services
- Preventive services required by the Patient Protection and Affordable Care Act as outline by MDHHS
- Prosthetics and orthotics
- Restorative or rehabilitative services in a place of service other than a nursing facility
- Sexually transmitted infections (STI) treatment
- Tobacco cessation treatment including pharmaceutical and behavioral support
- Therapies (speech, language, physical, occupational and therapies to support activities of daily living) excluding services provided to persons with development disabilities which are billed through Community Mental Health Services Program (CMHSP) providers or Intermediate School Districts
- Transplant services
- Vision services
- Well-child/EPSDT for persons under age 21
Healthy Michigan Members (HMP)
There are additional services covered for Healthy Michigan Plan Enrollees. The covered services provided to HMP Enrollees include all those listed above plus the following services:
- Habilitative services
- Dental services
- *Hearing aids
To improve your transportation services, we are changing our non-emergency medical transportation (NEMT) provider. Starting on December 1, 2020, One Call will be the new transportation provider for Aetna Better Health members. Look for more information about this change in your Member Newsletter. This change is only for Medicaid members.
What if I have re-occurring trips scheduled with MTM?
If you currently have reoccurring trips scheduled with MTM, we will make sure those trips are transitioned to One Call.
How do I schedule trips with the new provider One Call starting on December 1, 2020?
To schedule trips with One Call starting on December 1, 2020, call Aetna Better Health Member Services at 1-866-316-3784.
Will I lose any services due to the change?
No you will not lose any services. One Call will provide the same transportations services that you got through MTM. These services include
- Rides to and from the doctor
- Rides to and from the pharmacy
- Rides to and from the dentist for Healthy Michigan members and pregnant women
- Rides to and from the Member Advisory Council meetings for members on the councilWe are happy to have you as a member of Aetna Better Health. If there is anything we can do to assist you, please contact our Member Services department at 1-866-316-3784 Monday to Friday 8 a.m. to 5 p.m.
- Enhanced Fitness
- Weight Watchers
- Disease Management Sessions
- Tobacco Cessation
- Wellpass Text messaging - Two way communication with your care coordinator by text
- Dental deep cleaning (planing and scaling)
24-Hour Nurse Line - Línea de Enfermeras de 24 horas
When you have a health question, the best place to start is our FREE 24-Hour Nurse Line! Friendly registered nurses give expert advice and quick answers. They will help you decide what to do next - see your doctor, go to the emergency room or help you treat the problem at home. 1-866-711-6664 24-Hour Nurse Line/Línea de Enfermeras de 24 horas
VSP Vision Care
VSP is the vision care provider for Aetna Better Health of Michigan Members.
Eye care services are provided through our eye doctors. If you need glasses or an eye exam, just call 1-866-316-3784, TTY 711. You can also call a provider from our list of vision providers. For medical eye problems, talk to your PCP.
Inpatient & Outpatient Patient Services
- Semi-private room & board
- Routine nursing services
- Anesthesia, laboratory, radiology, pathology services
- Special care services (operating room, intensive care, and coronary care)
- Delivery room
- Nursery care for newborns
- Short term restorative and rehabilitative Nursing Care
- Transplant Services
- Office visits
- Surgery (when medically necessary)
- Doctor visits and services for hospitalized members
- Certified Nurse Midwife Services
- Professional Services
The following services are excluded from coverage. For more information on non-covered services see the Certificate of Coverage (COC) in the Member Handbook.
- Elective abortions and related services
- Experimental/Investigational drugs, procedures or equipment
- Elective cosmetic surgery
- Services provided by any out of network doctor (other than Emergency services or services with prior approval by Plan)
- Any costs incurred in connection with services that are not covered
- Services that are not Medically Necessary as determined by Plan, or a third party used by the Plan to perform utilization review services
- Services and supplies necessary to diagnose or treat any condition resulting from the Member's attempt to commit a crime or participate in illegal activities
- Charges for Member's failure to keep appointments
- Except as required by law, care provided in a government hospital or by a government-related health care provider
- Payment for services performed before the Enrollment Effective Date or after the Enrollment Termination Date
- Services paid by or provided for under worker's compensation, no-fault or other automobile insurance, any other insurance plan, any educational program, Medicare, CHAMPUS, and some other third-party payors
- Employment-related examinations
- Court-order examinations, tests, reports or treatment for mental health and
- Chemical Dependency/Substance Abuse or for parole/probation evaluations
- Cognitive Services
- Infertility treatment and related services
- Services related in any way to surrogate parenthood
- Cosmetic services or any services performed for cosmetic purposes
- Food and dietary supplements, vitamins, minerals and infant formula
- Long-term rehabilitative treatment provided through day treatment programs, residential/transitional facilities
- Fees, costs, and expenses incurred by a person who donates an organ or tissue, unless the recipient is a member of the Plan and the donor's own health plan does not cover the expenses
- Reversal of sterilization
- Testing to determine parentage or DNA testing
- Autopsies, except when provided because the Member died while in the hospital.
Member ID Card
You should carry your Member I.D. Card with you at all times. Your I.D. Card is the key to getting all of the health care services to which you are entitled.
The back of your card provides you with phone numbers to call in case of an emergency. It also tells providers how to get approvals and referrals. You will receive a Member I.D. Card for each covered member of your family. If you did not receive an I.D Card for each covered family member or need to add a new family member call us at 1-866-316-3784. If you need to replace a lost or stolen Member I.D. Card, call us.
Use your member I.D. number in the Member Portal
Your Primary Care Provider (PCP) - When you enroll with Aetna Better Health you are required to select a personal doctor. This doctor is known as your PCP. Your PCP is your health care manager who directs all of your health care services.
Some in-network services do not require a referral from your PCP. Call us at 1-866-316-3784 to find out more
You can choose a PCP from the Aetna Better Health Network. Use our online Find a Provider search.
Families covered by Aetna Better Health can select a PCP for each family member. For example, a Pediatrician may be selected for a child, an OB/GYN for mom, and an Internist for dad.
You may change PCPs at any time. Online at the Member Portal, or just call us at 1-866-316-3784.
Your PCP will arrange all specialty care. If you need to see a specialist, your PCP must give you a prescription or other piece of paper that tells the specialist why you need to be seen. No referral form is needed.
Accessing Behavioral Health Services
You may receive services from a local community mental health agency for substance abuse and mental health services. A referral is not needed to receive services directly from a community mental health agency.
Aetna Better Health of Michigan covers outpatient visits for behavioral health services. You can call Behavioral Health Services at 1-866-827-8704. You do not need to call your primary care doctor to get behavioral health services. If you have a serious behavioral health illness, you may be referred to the community mental Health Program in your county. If you’d like more information, just call Member Services at 1-866-316-3784, TTY 711.
Behavioral Health Services 24 hours at 866-827-4704
Drug & Alcohol Abuse
Signs of alcohol addiction (alcoholism)
Do you want to have more fun, to fit in, to cope better with your problems? It’s as easy as taking a drink — if you believe what you see on television. But if you think that alcohol will improve your life, you’re fooling yourself. Relying on alcohol to relax you or cheer you up can be dangerous. You may find yourself using it more and more in this way. This can lead to addiction. If this is happening to you, take action now to change your behavior and find caring people to help you.
Coordinating Your Care
We will help direct the care of members with health problems. Aetna Better Health has RNs to assist members, doctors and hospitals with making sure needed health care is performed when needed. Aetna Better Health will direct your care between the PCP, the specialist and the hospital.
We follow standard health care rules for routine screening, case management, and hospital stays. These rules are used by our health care staff to decide what treatment you should receive.
We review your benefits and coverage.
We do not give money to staff based on whether they approve or deny care. If you have questions on how care is approved, call us at 1-866-316-3784.
Beginning January 2020, to keep Healthy Michigan Plan (HMP) coverage, some Aetna Better Health HMP members will be required to complete and report 80 hours of work or activities every month. The work or activities could include:
- Having a job or income
- Being a student
- Looking for a job
- Volunteering (this activity can only be used for three months each calendar year)
- Doing job training
- Participating in a tribal employment program
- Participating in rehab (substance abuse)
- Doing vocational training
- Doing an internship
You can submit your work activities through MI Bridges at https://newmibridges.michigan.gov/ Register and log in to get started.
Anyone who is 19-62 years old and enrolled in the HMP will be required to report work or activities unless they are exempt (excused). Someone may be exempt (excused) for up to one year and the exemption can be renewed. In some cases, MDHHS will already know someone is exempt (excused) and will apply the exemption automatically.
Members can be exempt (excused) if they are:
- pregnant or were pregnant in the last 2 months
- medically frail
- the main caretaker for a family member under 6 (one parent per household)
- a full-time student
- under age 21 and were in Michigan foster care
- in prison or jail in the last 6 months
- getting State of Michigan unemployment benefits
- getting temporary or permanent disability payments from a private insurer or the government
- a medical condition that limits work, approved by a doctor
- caring for a dependent with a disability and has a doctor's order for full-time care (one claim per household)
- caring for a person who cannot make decisions for themselves
- Able to demonstrate a good cause circumstance such as experiencing a disability, hospitalization or serious illness
To claim an exemption, fill out and send MDHHS the Exemption form MSA-1905. The form can be found online by going to https://www.michigan.gov/healthymiplan/ and clicking on the link that says “Changes are coming to the Healthy Michigan Plan in January 2020.”
Members who are covered through HMP should have received a letter in September or October 2019. The letter either let members know that they were required to report work/activities, or that they were excused from reporting work/activities.