Member Benefits

Do you have questions about Aetna Better Health? Contact Aetna Better Health Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, seven days a week. The call is free.

Looking for a Medicare-Medicaid plan?

As an Aetna Better HealthSM Premier Plan member, you get benefits to help you be healthier.

It is a MI Health Link (Medicare-Medicaid) health plan for those who are 21 or older who qualify for both Medicare and Medicaid. This is also called “dually eligible.” We offer a full range of services, plus extra benefits to help you lead a healthier life.

You’ll have a care team that will work with you to make sure you get the care you need. You’ll also have a case manager who will coordinate all your services and help you with health care decisions.

Our members must live in one of these counties:

  • Region 4: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph or Van Buren County
  • Region 7: Wayne County
  • Region 9: Macomb County

Learn more about MI Health Link.

If you have questions about enrollment or disenrollment in MI Health Link, please call Michigan ENROLLS toll-free at 1-800-975-7630. Persons with hearing and speech disabilities may call the TTY number at 1-888-263-5897.

As a member of Aetna Better Health℠ Premier Plan, you have your own care manager as part of our care management program. Your care manager can help you find the right care and services. Your care manager will contact you soon after you are enrolled with us.

Your care manager will work with you, your doctors and other providers to make sure you receive the care and services that work best for you. The goal is to build a treatment plan to help you live a healthier life. Your care manager will meet with you by phone or where you live as often as needed.

Your care manager can help you with your health care needs. Below are examples of things that your care manager can help you with:

  • You have to go to the ER a lot
  • You have trouble getting things your doctor has ordered
  • Your doctor just told you that you have a disease like heart failure or diabetes and you’d like more information about your illness or treatment
  • You need help at home and would like to get long-term services and support
  • Your doctor wants you to see a specialist, but you don't know what to do

If you want to discuss your health care needs and questions with your care manager, call Member Services. Ask to speak to your care manager. Your care manager is there for you.

Extra support to care for you
We offer our disease management programs to our members who have chronic (ongoing) conditions. These include illnesses like asthma, diabetes, lung disease or heart disease issue.

What is a disease management program?
These programs provide education and outreach to you based on your medical needs. The goal is to help you be healthier and get quality care. If you choose to be part of our program, we work with your doctor to create a plan for your care. This plan will include goals that will help you and your doctor track your results. We’ll also provide education to you about how to stay well.

We have disease management programs for:

  • Asthma
  • Diabetes
  • Depression
  • Chronic obstructive pulmonary disorder (COPD)
  • Heart failure

Your care manager can give you the help you need. We will also connect you with other resources to help you manage your condition.

If you want to know more about our disease management programs, talk to your care manager. Or call Member Services and ask to speak with your case manager.

Behavioral health services are available to you through your local Pre-Paid Inpatient Health Plan (PIHP) provider network. If you receive services through the PIHP, you will continue to receive them according to your plan of care.

Medically necessary services include:

  • Behavioral health
  • Inpatient behavioral health admissions
  • Intellectual/developmental disability services including the Habitation Waiver
  • Substance use disorder services
  • Psychotherapy or counseling (individual, family and group)

See your PIHP member handbook for complete details. Or call Member Services at 1-855-676-5772 (TTY: 711).

 

Contact the 24-Hour Behavioral Health Crisis Line for any of the following reasons

  • Suicidal thoughts
  • Information on mental health/illness
  • Substance abuse/addiction
  • To help a friend or loved one
  • Relationship problems
  • Abuse/violence
  • Problems causing anxiety/depression
  • Loneliness
  • Family problems

If you are experiencing a life or death emergency, please call 911 or go to the nearest hospital.  

24-Hour Behavioral Health Crisis Lines & Community Behavioral Health Centers

Region 4
(Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, St. Joseph, Van Buren counties) Southwest Michigan Behavioral Health

  • General Information Line – 1-800-676-5814
  • 24-Hour Behavioral Health Crisis Line – 1-800-675-7148

Region 7
(Wayne County) Detroit Wayne Mental Health Authority

  • General Information Line – 1-800-241-4949
  • 24-hour Behavioral Health Crisis Line – 1-800-241-4949

Region 9
(Macomb County) Macomb County Mental Health

  • General Information Line – 1-855-996-2264
  • 24-hour Behavioral Health Crisis Line – 1-800-273-8255

Aetna Better Health℠ Premier Plan can help you get a ride to and from doctor visits. You can also get a ride to your local pharmacy after a doctor visit.  You may also apply for gas reimbursement to and from office visits.

If you need a ride, or would like help with gas costs, please call us at 1-855-676-5772 (TTY: 711) three days before your appointment. That gives us time to arrange this for you. If your need is urgent, we may authorize help without a three-day notice. For urgent care matters, let us know when you call to schedule a ride.

Aetna Better Health Premier Plan offers unlimited access to a registered nurse health line, 24 hours a day, 7 days a week, year round.

Feel good knowing that our Aetna Better HealthSM Premier Plan dental benefits cover:

  • Examinations, evaluations and cleaning once every six months
  • Cleaning once every six months
  • Silver diamine fluoride treatment with a maximum of six applications per lifetime
  • Bitewing X-rays once in a 12-month period
  • A panoramic X-ray and a full mouth or complete series of X-rays once every five years
  • Fillings and tooth extractions
  • Complete or partial dentures are covered once every five years

Aetna Better Health℠ Premier Plan offers the following vision services:

  • One routine eye exam each year
  • One pair of contact lenses or eyeglasses (lenses and frames) each year

Questions? Just ask your care manager or call Member Services.

For adults aged 21 and older, the plan pays for evaluation and fitting for a hearing aid twice per year and pays for a hearing aid once every five years. Referral and authorization are required.

We cover one adult routine podiatry visit every three months to take care of your feet.

Another benefit we provide is an adult weight management program. This includes health coaching to help you succeed.

We provide SilverSneakers®, a community fitness program that promotes greater health engagement and accountability with no cost to Aetna Better Health of Michigan members. SilverSneakers® provides members with regular exercise (strength training, aerobics, flexibility) and social support opportunities.

Starting in January 2019, you will be eligible for $90 in OTC supplies every three months. For more information, talk to your care manager or call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week.

Click here to order monthly OTC supplies.

We provide help for you to quit smoking. Talk to your care manager.

Eligible members can get Lifeline cell service PLUS an Android™ Smartphone at NO COST!

Assurance Wireless Lifeline service includes:*

  • Data Each Month
  • Unlimited Texts
  • Voice Minutes Each Month
  • PLUS an Android Smartphone!

EXTRA Aetna Better Health of Michigan Benefits include:

  • Health tips and reminders by text
  • Calls to Member Services that won’t count against your monthly minutes
  • One-on-one texting with your healthcare team

Already have Lifeline? It’s easy to switch to Assurance Wireless today!

Get Assurance Wireless Lifeline service + health extras from Aetna at no cost!

Coming Soon. Call Member Services at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week for more information.

National Coverage Determination Member Notification

The Centers for Medicare & Medicaid Services (CMS) sometimes change the coverage rules that apply to an item or service covered under Medicare and through your health plan that provides Medicare benefits. When these rules are changed, CMS issues a National Coverage Determination (NCD) and we are required to notify you of this information.

An NCD tells us:

  • What rule is changing
  • If Medicare will pay for an item or service
  • What item or service is covered

What does this mean to me?

We want you to be aware of any new NCDs that may affect your coverage. But new rules do not affect all members.

CMS has issued NCDs that apply to the following items/services:

This affects services given on or after January 21, 2020

Centers for Medicare and Medicaid Services (CMS) has issued National Coverage Determinations (NCD’s) that affect coverage for treatment. The recent NCD changes are as follows:

  • CMS will cover acupuncture for chronic low back pain (cLBP) effective for claims with dates of service on and after January 21, 2020.

This NCD expands coverage for acupuncture services specifically targeted for chronic low back pain. Medicare determined it will cover acupuncture for cLBP up to 12 visits in 90 days. These services will only be covered by Medicare if cLBP:

  • lasts 12 weeks or longer
  • nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc.
  • disease);
  • not associated with surgery; and
  • not associated with pregnancy 

If you think you qualify, speak with your physician.

 

This summarizes CMS transmittal R10128NCD 

This affects services given on or after March 16, 2018

The Centers for Medicare & Medicaid Services (CMS) reviewed the evidence for laboratory diagnostic tests using NGS in patients with cancer. They determined that some tests could improve health outcomes for Medicare beneficiaries with advanced cancer. Testing will be covered for beneficiaries with:

  • recurrent, relapsed, refractory or metastatic cancer
  • advanced stages III or IV cancer if the beneficiary either:
    • has not been previously tested using the same NGS test for the same primary diagnosis of cancer or
    • will get repeat testing using the same NGS test only when the treating physician gives a new primary cancer diagnosis and there will be further cancer treatment (e.g., therapeutic chemotherapy) 

The test must be ordered by the treating physician, performed in a Clinical Laboratory Improvement Amendments (CLIA)-certified laboratory, and have all of the following requirements met:

  • Food & Drug Administration (FDA) approval or clearance as a companion in vitro diagnostic; and,
  • an FDA-approved or -cleared indication for use in that patient’s cancer; and,
  • results provided to the treating physician for management of the patient using a report template to specify treatment options

This summarizes CMS transmittal R210NCD

This affects services given on or after April 10, 2018

Medicare will allow for coverage of MRI for beneficiaries under certain conditions with any of the following: implanted pacemaker, implantable cardioverter defibrillator (ICD), cardiac resynchronization therapy pacemaker (CRT-P), or cardiac resynchronization therapy defibrillator (CRT-D).

If you think you qualify, speak with your physician.

This summarizes CMS transmittal R208NCD

This affects services given on or after December 7, 2017.

 

Centers for Medicare and Medicaid Services (CMS) has issued National Coverage Determinations (NCD’s) that affect coverage for treatment done as part of special studies (Coverage with Evidence Development/CED, Medicare approved studies).  These changes only apply to members involved in the special studies.  The recent NCD changes are as follows:

  • You are having surgery on your lower spine where the surgeon uses a very small incision and surgery is guided with imaging (x-ray) assistance (often referred to as “Percutaneous Image-guided Lumbar Decompression”/PILD)
  • You have a condition where the open spaces of your spine are narrowed and this puts pressure on your spinal cord or nerves (“Lumbar Spinal Stenosis”) and you have not had relief with non-surgical treatments.
  • You meet all the other specified conditions of the Medicare approved study.

These services will only be covered by Medicare if they are provided in a Medicare-approved clinical study under Coverage with Evidence Development (CED.)

If you think you qualify, speak with your physician.

This summarizes CMS transmittal R196NCD.

This affects services given on or after April 3, 2017.

Local Medicare administrators will decide if they'll cover topical oxygen for the treatment of chronic non-healing wounds.

This summarizes CMS transmittal R203NCD.

This affects services given on or after January 18, 2017

Centers for Medicare and Medicaid Services (CMS) has issued National Coverage Determinations (NCD’s) that affect coverage for treatment done as part of special studies (Coverage with Evidence Development/CED, Medicare approved studies). These changes only apply to members involved in the special studies. The recent NCD changes are as follows:

Medicare will cover placement of a “leadless pacemaker” if you are enrolled in a special approved clinical study. A leadless pacemaker is placed without the need for a device pocket and insertion of a pacing lead which are parts of traditional pacing systems. You should speak with your doctor if you think you qualify to be a participant in an approved clinical study to receive this device.”

This summarizes CMS transmittal R201NCD

This affects services given on or after August 30, 2016

Centers for Medicare and Medicaid Services (CMS) recently released a notice in response to public questions around gender reassignment surgeries. This notice restates that there are no national CMS coverage guidelines for this service. Coverage decisions for this type of surgery are made by your local Plan, according to your benefits and your Plan’s medical necessity guidelines. If you have any questions about your coverage for this type of surgery, please contact Member Services at number on your Member ID.

This summarizes CMS transmittal R194NCD

This affects services given on or after February 8, 2016

Centers for Medicare and Medicaid Services (CMS) has issued National Coverage Determinations (NCD’s) that affect coverage for treatment done as part of special studies (Coverage with Evidence Development/CED, Medicare approved studies).  These changes only apply to members involved in the special studies.  The recent NCD changes are as follows:

  • Coverage will be approved for a special heart procedure (Left Atrial Appendage Closure, LAAC, if the device planned for use has FDA approval; and
  • You have a specific type of irregular heart beat (Non-Valvular Atrial Fibrillation, NVAF; and

You meet all the other specified conditions of the Medicare approved study. These services will only be covered by Medicare if they are provided in a Medicare-approved clinical study under Coverage with Evidence Development (CED.)

If you think you qualify, speak with your physician.

This summarizes CMS transmittal R192NCD

This affects services given on or after January 27, 2016

Centers for Medicare and Medicaid Services (CMS) has issued National Coverage Determinations (NCD’s) that affect coverage for treatment done as part of special studies (Coverage with Evidence Development/CED, Medicare approved studies).  These changes only apply to members involved in the special studies.  The recent NCD changes are as follows:

  • Expanded coverage for donor stem cell transplant (allogenic hematopoietic stem cell transplant) for sickle cell disease, certain diseases of the blood cells (myelofibrosis, multiple myeloma), other rare diseases. In a donor stem cell transplant, a doctor takes part of a healthy donor’s stem cell or bone marrow. This is then specially prepared and given to a patient through a tube in a vein (intravenous infusion). The patient also receives high dose chemotherapy (such as certain cancer drugs) and/or radiation treatments before getting this transplant through the vein.

This NCD expands coverage for donor HSCT items and services. These services will only be covered by Medicare if they are provided in a Medicare-approved clinical study under Coverage with Evidence Development (CED.). When bone marrow or peripheral blood stem cell transplantation is covered, all required steps are included in coverage.  If you think you qualify, speak with your physician.

This summarizes CMS transmittal R191NCD

This affects services given on or after October 9, 2014

Cologuard is a test that is performed on a stool sample to check for colon cancer. You no longer need authorization from your health plan before you have this test done.

This summarizes CMS transmittal R183NCD

This is effective for services on or after May 25, 2017.

The Centers for Medicare and Medicaid Services (CMS) issued an NCD to cover SET for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic PAD.

SET involves the use of intermittent walking exercise, which alternates periods of walking to moderate-to-maximum claudication, with rest. SET has been recommended as the initial treatment for patients suffering from IC, the most common symptom experienced by people with PAD.

The SET program must:

  • Consist of sessions lasting 30-60 minutes, comprising a therapeutic exercise-training program for PAD in patients with claudication
  • Be conducted in a hospital outpatient setting, or a physician’s office
  • Be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD
  • Be under the direct supervision of a physician (as defined in Section 1861(r)(1)) of the Social Security Act (the Act), physician assistant, or nurse practitioner/clinical nurse specialist (as identified in Section 1861(aa)(5) of the Act)) who must be trained in both basic and advanced life support techniques.

This summarizes CMS transmittal R206NCD.

To save yourself extra costs, you should make sure your services are covered by your health plan. You also need to receive services from facilities and/or providers in the Aetna Better Health℠ Premier Plan network. The only times you can see providers that are not in our network is when you need to visit or use:

  • Emergency services
  • A federally qualified health center or rural health clinic
  • An out-of-panel provider that we have approved you to see during or after your transition-of-care time period
  • Urgently-needed care

We provide services in only certain regions in Michigan. When you are out of our service area, you are only covered for emergency services. If you are out of the service area and need non-emergency services, call your PCP or Member Services.

Out-of-network and emergency care
Except in certain cases, like emergencies, you can’t visit a care provider outside of our network. Our network providers are listed in our directory. These providers have agreed to charge less for many services. If you don’t use in-network providers, you may be responsible for these charges.

If you have questions about this, call Member Services toll-free at 1-855-676-5772 (TTY: 711), 24 hours a day, 7 days a week. You also can use the Find a Provider search tool.

How do I know if it’s an emergency?
For more information about emergency care, please review your member handbook. You can also call your PCP. Or, call 1-855-676-5772  (TTY: 711) and select the option for our 24-hour Nurse Advice Line.