There are two important documents that can help you understand the full scope of your Aetna Medicare Advantage benefits: your Summary of Benefits and Evidence of Coverage.

You can access both documents via your plan web page (scan the the QR code on your member ID) or log in to your Aetna secure member website, at AetnaMedicare.com/Login.

Here's a quick breakdown of what you can find in each document.

1. Summary of Benefits (SB)

This is a summary of your plan's costs and coverage in an easy-to-read table format. It includes your specific plan premium, deductible and maximum out-of-pocket costs. It also breaks down your coverage into three categories.

• Medical and hospital benefits: This category includes hospital coverage, doctor visits, emergency and urgent care, tests and screenings, hearing, dental, vision, mental health services and more.
• Medicare Part D drugs: This informs you of your deductible and your share of the cost when you get one‑month or long-term supplies of a covered Part D prescription drug.
• Other covered benefits: Here is where you can find your benefits for over-the-counter (OTC) allowance, chiropractic services, diabetic supplies, fitness programs and more.

Get your health questions answered 

A registered nurse is just a phone call away. Call our 24-Hour Nurse Line at 1-855-493-7019 (TTY: 711) to speak with a nurse, 24 hours a day, 7 days a week. If it’s an emergency, dial 911. 

2. Evidence of Coverage (EOC)

Your EOC is a more detailed description of your plan’s costs and coverage. It covers the topics in your Summary of Benefits in much more detail. Plus, it has helpful information on how to get the most out of your plan, including how to:

• Get prior authorization for certain tests and procedures
• Appeal coverage decisions made by Aetna

You also have access to a formulary, or drug list. It lists the prescription drugs that are covered by your plan. You can download a copy from your plan web page or secure member website. Or you can visit AetnaMedicare.com/Formulary and enter your plan details to find your specific prescription drug coverage.

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We value your opinions. And this member newsletter survey is a great way to share feedback about your plan and the topics you care about. Take the survey now.

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See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.

For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within two weeks. You can call the number on your member ID card if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery.

The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.

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