Aetna Better Health of Virginia (HMO SNP) is available to people who have Medicare and who receive Medicaid assistance from the Commonwealth Coordinated Care Plus (Medicaid) and Dual Eligible Special Needs Plan (Medicare). Aetna Better Health of Virginia (HMO SNP) is a Medicare Special Needs Plan, which means our plan benefits and services are designed for people with special health care needs. Our plan offers additional benefits and services not covered under Medicare, such as dental, hearing aids, and eyewear. If you are a member of Aetna Better Health and enroll in the Aetna Better Health of Virginia (HMO SNP) we will coordinate your Medicare and Medicaid covered services for you.
To speak to someone for help with a complaint or information request, call 1-800-Medicare, or visit online.
Get to know your health plan
We offer our members additional benefits
Although Medicare is a Federal program, Aetna Better Health of Virginia (HMO SNP) is available only to individuals who live in our plan service area. To remain a member of our plan, you must continue to reside in the plan service area. The service area is all regions and all counties in the Commonwealth of Virginia.
Our service area includes these counties in the Commonwealth of Virginia:
Isle of Wight
King and Queen
Getting care when you need it
Getting care during a disaster
If the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to care from your plan.
For more information about the getting care during a disaster, refer to Chapter 3, Section 3 of Evidence of Coverage.
How to get care from out-of-network providers
If you choose to go to a provider outside of our network without a referral from your PCP or prior authorization from the plan, you must pay for these services yourself except in limited situations (for example, emergency care or for urgently needed services or dialysis services when traveling outside of the plan service area ). Neither the plan nor Original Medicare will pay for these services.
If you need medical care that Medicare or Medicaid requires our plan to cover and the providers in our network cannot provide this care, you can get this care from an out-of-network provider. You must obtain prior authorization before seeing an out-of-network provider. In this situation, we will cover these services as if you got the care from a network provider. For information about getting approval to see an out-of-network provider, please contact Member Services at 1-800-624-3879 (TTY 711). Calls to this number are free. You can call 8 a.m. - 8 p.m., seven days a week.
For more information on getting care from out-of-network providers, refer to Chapter 3, Section 2.4 of the Evidence of Coverage.
Appointment of representative
If you need help with a grievance, coverage decision or appeal, you can ask someone to act on your behalf by naming another person to act for you as your “representative.”
To give a friend, relative, your doctor or other provider, or other person the right to be your representative, call Member Services at 1-855-463-0933, TTY 711, and ask for the Appointment of Representative form. You also can download and print a copy of the Appointment of Representative form.
The form must be signed by you and by the person whom you would like to act on your behalf. The completed and signed form is valid for one (1) year.
If your representative holds durable power of attorney or guardianship papers, an Appointment of Representative form is not required.
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?
Stem Cell Transplantation for Multiple Myeloma, Myelofibrosis, Sickle Cell Disease, and Myelodysplastic Syndromes
Percutaneous Left Atrial Appendage Closure (LAAC)
- 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.
Test for Colorectal Cancer using Cologuard
Gender Dysphoria and Gender Reassignment Surgery
Percutaneous Image-guided Lumbar Decompression (PILD) for Lumbar Spinal Stenosis (LSS)