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The Aetna Better Health® difference
You deserve to be as healthy as you can be. That’s why we offer unique benefits that take care of the whole you. We have experience you can count on — with a range of services to help you on your health journey. We’ve added some benefits that go beyond your standard health coverage. Here’s a list of your extra benefits (PDF).
Pregnancy and newborn care
Are you expecting a child? We’ll help you stay healthy during your pregnancy. And you can earn rewards when you make healthy choices while pregnant and after the baby is born.
Kids' health
As your child grows, we’ll reward you when you help them stay healthy. For example, you can earn money toward the cost of a health-related summer camp.
Teens’ and preteens’ health
Members between the ages of 12 and 18 can also earn rewards for healthy choices. Earn a $25 gift card for a teen or preteen’s yearly wellness visit and more.
Diabetes care
If you have diabetes, we’re here to help you take care of it. You can also earn rewards when you take steps to manage your diabetes. For example, you can get a $25 gift card for completing an eye exam.
Benefits in your plan
Benefits in your plan
Learn about all your plan benefits, from vision and dental care to maternity care. You can learn more about all these topics in your member handbook (PDF).
Fee-For-Service benefits
Some benefits, like nursing facilities or organ transplant, are covered by Medicaid, not Aetna Better Health. Those are called Fee-For-Service benefits. You can find a list of them in your member handbook (PDF).
Copays
Members may have copays for some services. You can check your member handbook for a list. Have questions? Just call us at 1-888-348-2922 (TTY: 711), 24 hours a day, 7 days a week.
Referrals
You don’t need a referral from your primary care provider (PCP) to see another in-network doctor. Just be sure to tell your PCP if you plan to see another doctor. That way they can coordinate your care.
Approval for services
Some services need approval, or prior authorization (PA), before you get them. We base all our decisions on whether the service is:
- Needed for your health
- Likely to help you
- Covered
You can learn more about PA. Just visit our PA page.
We take care of the whole you. That means you’re covered if you need to see a specialist, have an emergency or plan to start a family.
You can also get a wide range of preventive care and vaccines. Start by finding a provider today.
A healthy smile goes a long way. Dental care is part of your overall health. That’s why you should see your dentist every six months.
Check your member ID card from your dental plan. Then, call your plan for answers to questions about care and coverage.
Routine eye exams are an easy way to keep your eyes healthy. We work with VSP® Vision Care to offer you covered services like:
- Eye exams, lenses, frames and needed repairs for children under 21
- Contact lenses for adults and children with certain conditions
- Treatment and one pair of glasses after cataract surgery
You don’t need a referral to see a provider in the network. Just be sure to show your member ID card at every appointment. To learn more, contact VSP Vision Care at 1-800-877-7195.
To find a vision provider, visit the VSP website.
We help you manage drugs you get while at your doctor’s office, in the hospital or at an infusion center. We do not handle the drugs your doctor prescribes that you pick up at a pharmacy. Gainwell Technologies, your pharmacy benefits manager (PBM), handles those.
You deserve to be healthy in body and mind. Your plan covers health for you as a whole person. That includes help with your mental health or substance use. You or your child can go to any behavioral health provider in our network.
Help in a crisis
Call 911 or go to the nearest hospital if:
- You have thoughts of harming yourself or someone else
- You have an emergency and need help right now
You can use any hospital for emergency care, even if it isn’t in our network. Just show your member ID card.
You can also call:
- Us at 1-888-348-2922 (TTY: 711). Choose the option for the Crisis Line. We’re here for you 24 hours a day, 7 days a week.
- The National Suicide Prevention Lifeline: 1-800-273-8255 (TTY: 711)
We can help you and your baby be as healthy as possible. When you take part in our Healthy Pregnancies, Healthy Babies program, here are some benefits you’ll enjoy:
- Healthy pregnancy and baby care tips
- Rewards you can earn
- Help from a case manager if you have a high-risk pregnancy
- Support from local programs and resources
We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. Any family planning care that you get is private. You can call us at 1-888-348-2922 (TTY: 711) to choose a family planning provider. Or you can read more about family planning.
With EPSDT, kids under 21 can get full preventive health care services at no cost. This includes health and wellness visits, like:
- Annual checkups
- Dentist visits
- Eye doctor visits
Why do these visits matter? They can help doctors treat symptoms before they get worse. And in some cases, they can help prevent health issues before they start.
Have questions? Just call us at 1-888-348-2922 (TTY: 711).
Do you need help getting care? Our care management team is here for you. Case managers are nurses and social workers who understand your health conditions and help connect you to the right care. A case manager can help you learn more about your health, find a ride to your appointments and more.
Learn more about care management
Chronic disease management
Some health issues need more care. Our case managers can help you manage chronic conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.
If it’s late at night or you can’t reach your PCP, you’re not alone. You can speak with a nurse about your health care questions 24 hours a day, 7 days a week. Not sure if you should find urgent care or go to the emergency room? The Nurse Line can help. It doesn’t take the place of your PCP, so be sure to follow up later.
To reach the 24-Hour Nurse Line, just call 1-855-200-5975 (TTY: 711).
It’s important to stay in contact with your health care team. And to be able to receive health tips and reminders by text. Need a smartphone? You can get one through Assurance Wireless® Lifeline at no cost to you. Your smartphone will include services, like:
- Unlimited texts
- 1,000 talk minutes
- 4.5 GB of data each month, all on the T-Mobile Network
To see if you’re eligible for Assurance Wireless, go to Apply for your smartphone.
Apply for your smartphone
If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency for all members.
If it’s not an emergency, and you don’t have a ride to get care, we can help. You can get rides to the medical services we cover, like:
- Doctor visits
- Dental care
- Behavioral health care
Just call ModivCare at 1-844-549-8353 or visit their website to schedule a ride. Be sure to schedule it at least two business days in advance.
Special programs
These programs can help you live life as healthy as you can. We have special programs and services to help you get the care you need. And prevent health issues in the future.
Other language and format needs
Need language help? Just call us at 1-888-348-2922 (TTY: 711). We’re here for you ${member_services_hours}. You can get:
- Interpreter services at no cost during any service or complaint process, including American Sign Language and real-time oral interpretation
- Interpreter services for your medical visit (be sure to call 48 hours before your visit)
- Info in another format, like audio CD-ROM, large print and braille
- Materials in other languages if your primary language isn’t English
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