Aetna Better Health Premier Plan

The Aetna Better Health Premier Plan is a Medicaidmanaged care offering designed for individuals and families who qualify for Medicaid benefits in participating states. It combines comprehensive medical coverage with a range of additional services aimed at improving health outcomes, reducing costs, and simplifying the enrollment experience.

Key Features

• Integrated Care Network: Access to a broad network of primary care physicians, specialists, hospitals, and community health centers.
• No Premiums or Copayments: Eligible members typically pay no monthly premium and face little or no costsharing for most services.
• Preventive Care Emphasis: Full coverage for routine exams, immunizations, screenings, and wellness visits.
• Prescription Drug Coverage: Comprehensive formulary with generic and brandname drugs covered at no cost.
• Behavioral Health Services: Mental health counseling, substanceuse treatment, and psychiatric care are fully included.
• Telehealth Options: Virtual visits with primary care providers and specialists are available 24/7.
• Care Coordination: Dedicated health coaches help members navigate the system, manage chronic conditions and schedule appointments.

Eligibility & Enrollment

Eligibility is based on Medicaid qualification criteria in each state that participates in the Aetna Better Health Premier Plan. Common qualifying factors include:

• Income at or below the federal poverty level (FPL) or a designated percentage of FPL.
• Pregnant women, children, elderly adults, and individuals with disabilities.
• Residents of a participating state who meet Medicaid enrollment requirements.

Enrollment can be completed online, by phone, or in person at a local enrollment office. The process typically takes a few minutes, and once approved, members receive a member ID card within 710 business days.

Covered Benefits

How to Use Your Plan

Finding a Provider

Use the online provider directory to locate doctors, hospitals, and clinics that accept the plan. Call the member services number on the back of your ID card for assistance.

Scheduling an Appointment

1. Choose a network provider.
2. Call the providers office and mention your Aetna Better Health Premier Plan.
3. Bring your member ID and a photo ID to the visit.

Using Telehealth

Log in to the Aetna telehealth portal or download the mobile app. Select new visit, choose the type of care needed, and connect with a qualified clinician within minutes.

CostSharing Rules

For most covered services, there is no costsharing. However, a few exceptions may apply:

• Nonnetwork providers may incur outofpocket fees.
• Elective services not deemed medically necessary a small copayment may be required.
• Durable medical equipment may be subject to a nominal costshare.

The plans Summary of Benefits provides a detailed breakdown of any potential charges.

Appeals & Grievances

If you disagree with a coverage decision, you have the right to appeal:

1. Contact the provider who made the decision.
2. Submit a written request to Aetna Better Healths Member Services department.
3. If the issue remains unresolved, you may request an external review.

Frequently Asked Questions

Do I need a referral to see a specialist?

Generally, a referral from your primary care physician is required for specialist visits, though some urgent or emergency situations are exempt.

Can I keep my current doctor?

If your doctor participates in the Aetna Better Health Premier network, you can continue seeing them. Use the provider search tool to confirm network status.

What if I move to another state?

The plan is statespecific. If you relocate, youll need to reenroll in the Medicaid program of your new state and confirm eligibility for a local Aetna Better Health offering.

Are there any limits on prescription drugs?

The plan follows a formulary that includes most FDAapproved medications. Prior authorization may be required for certain brandname drugs.