Is An Aetna Medicare Part D Rx Plan (PDP) Right For Me?
When selecting a Medicare Part D plan, it is important to know that you will receive the benefits you need. You want to find out if your prescriptions are covered by the plan, if it includes doctors, hospitals and pharmacies in your area and whether your health care provider accepts the plan.
Aetna Medicare offers three different Part D plans that provide Rx coverage in each state. You can choose among the Aetna Medicare Essential, Plus or Premier Rx plan.
Aetna Medicare Part D Rx plans provide:
- More than 60,000 pharmacies in the national network
- Coverage for most Medicare Part D prescription drugs
- $0 deductible in most plans
- Convenience and savings opportunities using the prescription drug mail order program
- Predictable co-pays to help you manage prescription drug costs
- A safeguard against unforeseen changes in your prescription drug needs
The Aetna Medicare Part D RX plans have many benefits, but also some limitations.
Is My Pharmacy Included?
While Aetna Medicare Part D Rx Plans (PDP) cover most of your Part D brand-name and generic prescription drugs, you need to check the Aetna Medicare Preferred Drug List, also known as the Aetna formulary, to find out with brand-name and generic drugs are included. You can call Aetna Member Services toll-free number at 1-800-213-4599 to get the list or download it from their website.
To fill your prescription, you have more than 60,000 network pharmacies to chose from. Check with your current pharmacy to see whether it is included, and if not, call Aetna Member Services toll-free number at 1-800-213-4599 to find a pharmacy close to you.
Home Delivery
With Aetna Rx Home Delivery® Aetna offers a prescription mail service for Aetna pharmacy benefit members for their maintenance medications that treat chronic conditions such as arthritis, asthma, diabetes, high cholesterol, heart conditions, or high blood pressure. The Aetna Specialty Pharmacy service also provides convenient, mail-order services for medications that require special handling, storage or shipping. These are drugs that treat certain conditions such as hepatitis, psoriasis, rheumatoid arthritis and multiple sclerosis.
Can I Get Reimbursement If I Use An Out Of Network Pharmacy?
When you get your prescription drugs a pharmacy that is not included in the Aetna network, you may have to pay the full cost of the drug when you get your prescription. To be reimbursed for Aetna’s share of the cost of the drug (minus your copay), you have to submit a claim form to Aetna. You may need to pay an additional cost for drugs received at an out-of-network pharmacy. Make sure to submit your claim within three months after the end of the plan year.
How Often Can I Refill?
Aetna’s refill policy promotes the safe and appropriate use of medications. Follow these guidelines for getting refills on your prescriptions:
Retail Pharmacies
- You may refill a supply of 9 days or less after you have used 50 percent of the prescription.
- You may refill a supply of 10 days or more after you have used 75 percent of the prescription.
Mail Order Pharmacies
- You may refill a supply of 30 days or less after you have used 50 percent of the prescription.
- You may refill a supply of 31 to 60 days after you have used 60 percent of the prescription.
- You may refill a supply of 61 days or more after you have used 66 percent of the prescription.
Am I Eligible For An Aetna Medicare Part D Rx Plan?
Generally, you can apply for an Aetna Medicare Rx® Plan (PDP), regardless of your health, if you meet the following Aetna Medicare Rx eligibility guidelines:
- You are entitled to Medicare Part A and/or enrolled in Medicare Part B, and
- You live in the plan service area.
To join an Aetna Medicare Part D Rx® Plan (PDP):
- You must enroll during the Annual Enrollment period November 15 – December 31, or
- You must be within your initial enrollment period (starting three months before and lasting for three months after you first qualify for Medicare), or
- You must qualify for a special enrollment period, such as when you move to a new service area or into an institution, or your Medicaid eligibility changes.
Even if you don’t take a lot of prescription drugs now, getting Medicare Rx coverage when you become eligible helps you avoid penalties in the future and ensures you are covered if you need to take prescription drugs in the future.
