As an Aetna Medicare Advantage plan member, it’s good to know when you should see your primary care physician and when you should seek other types of care. That way you can save time and money for minor conditions and, more importantly, access the right care for serious health issues. Following are some general guidelines for deciding when you should use your PCP or other types of medical visits or services.

What is a “PCP” and what does the PCP do for you?

Under your plan coverage, you can select a network or out of network PCP. Your PCP can help you stay healthy, treat illnesses and coordinate your care with other health care providers.

Depending on where you live, the following types of providers may act as a PCP:

• General practitioner
• Internist
• Family practitioner
• Geriatrician
• Physician assistants (Not available in all states)
• Nurse practitioners (not available in all states)

For a complete listing of PCPs in your area please refer to your Provider & Pharmacy Directory or go to AetnaMedicare.com/en/find-doctors-hospitals/find-provider.html.

When to see your primary care physician

A primary care physician is essential to your health. Your PCP is the first line of care to help you stay healthy and treat illnesses. You can choose your PCP, no referral required, from our strong network of providers. They are your best option for advising, arranging and coordinating all covered services in your plan.

Your PCP is the right choice for:

• Preventive care
• Regular checkups
• Treating illnesses and ongoing conditions
• Getting medical advice
• Coordinating other covered services

For example, if you haven’t done so already, there are two important visits you should schedule with your PCP each year.

*First, an annual wellness visit to develop or update a personalized prevention plan.

*Second, an annual physical exam. An annual physical typically involves an exam by a doctor along with bloodwork or other tests.

Note: The annual wellness visit generally doesn't include a physical exam, except to check routine measurements such as height, weight and blood pressure.

Remember, you always have the option to switch to a new PCP. If you need to switch or would like to sign up for a new PCP, you can search for providers in our network by visiting AetnaMedicare.com/en/find-doctors-hospitals/find-provider.html. Or call us at the number on your member ID card.

Your secure member website is waiting. To check your coverage and benefit costs, go to your personal plan page — it’s listed on your Aetna Member ID card. Register now.

What is the role of a PCP in coordinating covered services?

Your PCP will provide most of your care, and when you need more specialized services, they will coordinate your care with other providers. They will help you find a specialist and will arrange for covered services you get as a member of our plan. Some of the services that the PCP will coordinate include:

• X-rays
• Laboratory tests
• Treatment from medical professionals like physical therapists
• Care from doctors who are specialists
• Hospital admissions

Have you visited your plan web page?

It has details about your personal coverage and how to make the most of your plan. You can find the website on your Aetna Member ID card.

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Coordinating your services includes consulting with other plan providers about your care and how it is progressing. Since your PCP will provide and coordinate most of your medical care, we recommend that you have your past medical records sent to your PCP’s office.

What is the role of the PCP in making decisions about or obtaining prior authorization?

In some cases, your PCP or other provider or you as the enrollee (member) may need to get approval in advance from our Medical Management Department for certain types of services or tests (this is called getting “prior authorization”). Obtaining prior authorization is the responsibility of the PCP, treating provider or you as the member. For questions or help, please call the Member Services number on your member ID card.

Here are some other health services for you to consider:

PCP telehealth visits*

You can connect with participating PCPs (and other telehealth providers) virtually. Simply connect using with a smartphone using the Aetna telehealth app or over the phone. Learn more at AetnaMedicare.com/Telehealth

Healthy Home Visits*

For help managing your care from the comfort of home, you can choose a Healthy Home Visit. With this option, one of our trusted licensed health care professionals will come to you — at no extra cost. All health care professionals will follow the guidelines and safety measures of the U.S. Centers for Disease Control and Prevention during the visit. In these visits, a licensed health care professional can:

• Review your health needs
• Perform a health assessment
• Review your medicines

When to seek urgent care at a clinic

It’s best to visit a walk-in clinic or urgent care center when you experience sudden health issues that aren’t life threatening or severe. These can include sprains and moderate injuries. These locations tend to have shorter wait times compared to the emergency room.

When to visit an emergency room

You may experience more severe health issues that require immediate care. If you experience sudden health issues, you may require a visit to the ER. If you believe that your symptoms are life threatening, you should call 911.

If you are unsure where to get services, ask a nurse 24/7

Sometimes it’s unclear where you should go for your medical services. Sometimes you need a quick answer to a health question. Maybe your concern can't wait until you see your doctor. You can talk to our registered nurses day or night on our Medicare Nurse Line** to get help with:

• Deciding whether to visit a doctor or urgent care center
• Understanding your symptoms
• Managing chronic conditions
• Learning about treatment options and medical procedures

To reach one of our nurses, see your member ID card, or call 1-800-556-1555 (TTY: 711), 24 hours a day, 7 days a week.**

If you need urgent or emergency care, call 911 and/or your doctor immediately or go to your closest emergency room. (ER)

FOOTNOTES

* Please note that home or telehealth visits don’t replace your relationship with your primary care physician. Instead, they coordinate with your primary care physician to manage your care and tell you about health programs and services you may need.

**Staff on the nurse call line cannot diagnose, prescribe or give medical advice. Call your doctor with any questions or concerns about your health.

For language services, please call the number on your member ID card and request an operator. For other language services: Español | 中⽂ | Tiếng Việt | 한국어 | Tagalog | Pусский | ةيبرعلا| | Kreyòl | Français | Polski | Português | Italiano | Deutsch | ⽇本語 | فارسی | Other languages…

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. The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other 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.

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