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What’s covered?

We provide our members with Medi-Cal coverage. We offer a wide range of benefits and services, so our members can reach all their health goals. You can learn more about our policies and guidelines by clicking the button below.

The Aetna Better Health difference

 

At Aetna Better Health of California, we help members live their best life. That’s why we offer a variety of specialty services to help them reach all of their health goals. We have experience that you can count on. And we’re always ready to help members out on their path to better health.

Maternity Matters program

Aetna Better Health of California now has a new program called Maternity Matters for pregnant members and new moms. It is important to have a healthy pregnancy and Maternity Matters is here for support. Pregnant members and members who are new moms who complete healthy activities can get rewards for items like diapers, wipes, pack n’ plays and baby formula. Members can call 1-855-772-9076 for more info and for help getting started with the Maternity Matters program.

Neonatal Abstinence Syndrome (NAS) program

Our NAS program offers care for moms and infants who need it. NAS is a form of drug withdrawal in newborn infants. It can happen when a mom uses certain medicines or drugs during pregnancy. We’ll connect moms at risk with a case manager, who’ll help them get special care during pregnancy. And they’ll help the child get special care after they’re born. Eligible members can join the NAS program starting in 2021. Members can call Member Services at 1-855-772-9076 (TTY: 711) for info or for help enrolling in the program.

Do you have any questions?

If you have any questions, you can call Provider Services at 1-855-772-9076 (TTY: 711).

Included benefits

At Aetna Better Health® of California, we take care of the whole member no matter where they are on their path to better health. That means they’re covered if they need to see a specialist, have an emergency or are planning to start a family. We also offer a wide range of preventive care services and vaccinations.

 

Some diseases call for a little extra care. We cover care for chronic conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more. We’ll help members manage their conditions and teach them how to live their healthiest lives possible. 

 

Health and Wellness Quick Reference Guide 

The purpose of this Quick Reference Guide is to provide an overview of member outreach campaigns, health and wellness programs, and member incentives program.

 

Learn more about caring for chronic conditions

 

Find local providers

Click here for Medi-Cal Rx Homesite

 

To find pharmacies that accept Medi-Cal Rx, use the “Find a Medi-Cal Rx Pharmacy” Tool located on the Medi-Cal Rx Homepage

We take care of our members who aren't quite feeling like themselves. Mental health is a very important part of our members’ overall health. That’s why we cover a variety of specialty mental health services. We have benefits that extend to members who need:

 

  • Outpatient care
  • Specialty mental health services
  • Substance abuse services
  • Treatment for autism

Learn more about our integrated behavioral health services

Sometimes, our members need a little extra help getting to and from their doctors’ appointments. We’ll give them a ride if their condition prevents them from driving or taking public transportation to their appointments. With no out-of-pocket costs, we’ll cover:

 

  • Emergency rides
  • Rides to their doctors
  • Rides to other specialty services covered by their plan

Learn more about members’ transportation benefits

 

Transportation information for providers 

 

California's state plan for assurance of transportation

Going to routine eye exams is an easy way for members to keep their eyes bright and healthy. Members don’t need a referral when they see a vision provider in our network. We offer routine covered eye exams and other vision services for children and adults. 

 

Find a vision provider

A healthy smile goes a long way. Dental care is a very important part of our members’ overall health. Dentists can help prevent unwanted pain and infections when members go to their covered checkups twice a year. Denti-Cal covers regular cleanings, X-rays and any other services that are medically necessary. To learn more , visit the Denti-Cal website.

 

Learn more about Denti-Cal

 

 

Aetna Better Health of California Diabetes Prevention Program – a new lifestyle change program that may help members adopt healthy habits, lose weight, and reduce their risk of developing type 2 diabetes. It is available at no cost to members.

 

The program focuses on healthier eating, increased physical activity, and managing the challenges that are associated with lifestyle changes.

 

Members will work with a personal coach and small group support to focus on healthy food choices and more activity. Members may qualify for tools such as wireless scales and/or activity trackers such as a Fitbit.

For more information:


-Visit solera4me.com/aetnabetterhealthca or
-Call 1-888-913-4508 Monday through Friday, 9 a.m. to 9 p.m. EST

 

Related forms:

 

DPP Provider Referral-vf (PDF)

 

Solera Physician Data Sheet (PDF)

Health Homes Program (HHP) provides services for members with certain chronic health conditions. These services are to help coordinate physical health services, behavioral health services, and community-based long-term services and supports (LTSS) for members with chronic conditions.

 

Members may be contacted if they qualify for the program. They can also call Aetna Better Health of California, or talk to their doctor or clinic staff, to find out if they can receive HHP services.

 

Covered HHP Services:

 

The Health Homes Program will give members a care coordinator and care team that will work with them and their health care providers, such as their doctors, specialists, pharmacists, case managers, and others, to coordinate care. Aetna Better Health of California provides

 

HHP services, which include:

 

  • Comprehensive Care Management
  • Care Coordination
  • Health Promotion
  • Comprehensive Transitional Care
  • Individual and Family Support Services
  • Referral to Community and Social Supports

 

Members may qualify for HHP if they have certain chronic health conditions. They can call Aetna Better Health of California to find out the conditions that qualify; and

 

They meet one of the following:

 

  • Have three or more of the HHP eligible chronic conditions
  • Stayed in the hospital in the last year
  • Visited the emergency department three or more times in the last year
  • Do not have a place to live

 

Related forms:

 

Fillable_Health Homes Program Patient Referral Form - Sacramento (PDF)

 

Fillable_Health Homes Program Patient Referral Form - San Diego (PDF)

 

Fillable_HHP Risk Tier and Priority Questionnaire - Sacramento (PDF)

 

Fillable_HHP Risk Tier and Priority Questionnaire - San Diego (PDF)

 

What is palliative care?

 

Palliative care is a way to improve quality of life for someone with a serious illness. To “palliate” means to ease symptoms like:

 

  • Pain
  • Nausea
  • Vomiting
  • Anxiety
  • Constipation
  • Sleeping problems
  • Breathing problems

 

Emotional and spiritual support for patients and their loved ones is part of palliative care. It happens at the same time as standard medical care. Active treatment for the illness doesn’t stop. Patients and their families help lead the plan of care with the provider team.

 

 

Goals of palliative care

 

 

Ease symptoms that cause distress

Easing symptoms is the main goal. Symptoms can affect a person’s ability to eat, be active or spend time with others. Providers use medicines as well as other ways to ease these symptoms. This gives people a better quality of life during treatment for an illness.

 

Coordinate care

This means that all the providers know the goals of care. The care team communicates regularly to ensure they can meet these goals.

 

Meet emotional and spiritual needs

The care team helps both patients and families cope with emotions. Illness can lead to stress, depression, anxiety and other issues. If they wish, patients and families can set up meetings with a counselor or spiritual advisor.

 

Give info and help with decisions

Care providers can help people and their families get the info they need. They can also help with making care decisions.

 

Create an advance care plan

This plan includes legal documents with a person’s wishes for their future. When people can’t speak for themselves, providers and families can still carry out their wishes. 

 

 

Being part of the palliative care team

 

A team of people give palliative care. They focus on the physical, emotional, and mental and social parts of a serious illness. The team may include:

 

  • Palliative care providers or nurses
  • Social workers
  • Pharmacists
  • Dietitians
  • Counselors
  • Spiritual advisors
  • Others

 

To get the most from palliative care, providers, patients and their loved ones all have a role.

 

 

What providers can do

 

 

Encourage your patients to think about palliative care if they need it. Help them find services in their area.

 

To provide the best care, ensure that patients and their families understand their illness and the goals of their care. Are they having pain and other symptoms? If needed, provide a palliative care referral.

 

Explain that treating these symptoms is best for their health and quality of life. Ask them to speak up if they need support in other ways. As part of their care team, you can help them get what they need.

 

Questions about palliative care? Just call us at 1-855-772-9076 (TTY: 711)

We recognize that substance use disorder (SUD) is a public health concern, with increasing use of opioids for pain relief, as well as increasing deaths from overdose of these drugs.

 

Members have access to our Opioid Management program, which:

 

  • Identifies those using opioids for pain management with a potential for opioid overuse
  • Explores evidence-based alternatives for pain management

 

The primary goals of pain management are to help improve and maintain function and improve quality of life. Our case management team can help members who have problems with misuse or abuse of these drugs. We can help them get treatment for the:

 

  • Substance use disorder
  • Cause that led to the initial drug use

 

Members with needs related to opioid use can get help with:

 

  • Using the health care system
  • Education
  • Coordination of care
  • Referrals
  • Communication with providers

 

Let’s work together to let members know about the Opioid Management program. Would you like to refer a member to this program or learn more? Just call 1-855-772-9076 (TTY: 711).

Personalized support

Personalized support

Sometimes, members need extra care to feel healthy. If they live in San Diego County, then they may be eligible for our long-term care program. Our care managers will be there to help them every step of the way on their paths to better health. Learn more about our wide range of long-term care services, like assisted living, meals and rides.

Learn more about the plan

Download for complete coverage information
 

Our member handbook is a great resource for all member needs. It has everything they need to know about their health care plan. They'll also find important phone numbers, addresses and much more.

 

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How members can access their benefits

How members can access their benefits

It’s easy for members to use their Aetna Better Health of California benefits and services. They’ll have access to things like preventive care, emergency care, pregnancy-related services, nursing home care and more. They just have to bring their Aetna Better Health ID card and their Medi-Cal Benefits Identification Card (BIC) to their appointments.

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