Three Aetna D-SNP members share how their care teams changed their lives and health for the better
Health insurance can be one of those things you wish you didn't have to think about much. But at the same time, you’re happy it’s there when you need it. That was the case for Maria, John and Dwayne, all members of an Aetna® Dual Eligible Special Needs Plan (D-SNP). When these three members each faced a personal health crisis, their health plan came to the rescue.
For each member, the saving grace was an Aetna care team. It’s something every Aetna D-SNP member has. A care team is a dedicated group of health care workers, such as nurse care managers and social workers. They work closely with other health care teams and medical team providers. Their goal: to make sure members get the best care and benefits for their personal needs. Read on to see the difference an Aetna care team can make.
Aetna® care teams can help you find a doctor, schedule appointments, manage a condition, access the right benefits and more. It’s a personal benefit designed for Aetna Dual Eligible Special Needs Plan members.
When Maria enrolled in an Aetna D-SNP, her care manager, Carey, reached out to welcome her. During that first call, Carey noticed a possibly life-threatening problem. Maria had diabetes, but her glucometer wasn’t working. Maria couldn’t check her blood sugar levels, a major step in managing diabetes.
Carey quickly ordered Maria a new glucometer. Then she followed up after it arrived. That’s when Carey learned that Maria’s blood sugar was dangerously high. Over time, high levels like this can damage organs, including the heart and kidneys.* They can also cause coma or even death. Maria was also down to her last test strip. So she bought more, only to find that they didn’t work with the new device.
Carey knew she had to act fast to keep Maria safe. She called an Aetna pharmacist to verify coverage and learned that a simple mistake was behind the problem: The local pharmacy entered the wrong code for the strips. Carey called Maria’s pharmacy to fix the error. Maria picked up her new test strips that day. She also got a refund for the strips she had to buy.
Now Maria has all the tools she needs to take care of her diabetes. She closely monitors her blood sugar. And her doctor has been able to change her medicine to keep her levels in a good range. Maria also has other health conditions. So it’s even more important that she keeps her diabetes under tight control. This goal is much easier to reach, thanks to Maria’s care team.
John was homeless when he began working with Carrie, his D-SNP care manager, and Jenny, his D-SNP social worker. He was just sent home from the hospital. And with no place to call home, he was having a lot of panic attacks.
This made it hard for John to focus or take care of his many health issues. He suffered from:
Congestive heart failure
Chronic obstructive pulmonary disease (COPD)
Chronic renal failure
A history of substance abuse
On top of all that, he had no providers for follow-up care. And someone stole his medicine from the homeless shelter where he was staying.
Carrie and Jenny knew that to get John on the road to recovery, he needed two key things: stable housing and medical providers. Even as John moved from shelter to shelter, Carrie and Jenny kept in touch with him. They helped him set up follow-up doctor visits. They also gave him the emotional support he needed.
Today, John has a secure home and a primary care provider (PCP). He’s up to date on all his medicines. And he keeps in close contact with his D-SNP care team to work on his health goals. As he tells Carrie and Jenny, “I don’t know where I would be if you guys didn’t help me.”
Dwayne has a history of diabetes and high blood pressure. He had just left the hospital when he came down with COVID-19. But all the family members he lived with had the illness too. They were isolated and alone, and Dwayne didn’t have the medical supplies and medicine he needed to treat his conditions.
That’s when Stephanie, Dwayne’s D-SNP case manager, reached out. Stephanie called to talk about Dwayne’s transition from the hospital to his home. She wanted to tell him about the resources Aetna could offer to help. As they talked, Stephanie learned that Dwayne needed vital supplies. On the list: diabetic supplies and a prescription refill. She also learned that Dwayne was not yet set up with his new primary care provider (PCP). This explained why the pharmacy wouldn’t refill his prescriptions.
Dwayne was feeling overwhelmed. So Stephanie jumped in to help. Her first step: Look for local meal delivery services in the area. She quickly found several options for Dwayne to have meals delivered to his home.
Stephanie’s next call was to Dwayne’s primary care provider. After speaking with the PCP, Stephanie set up a telehealth visit for Dwayne. That online visit meant Dwayne could now get the medicine and supplies he needed. Thanks to Stephanie’s support, Dwayne was able to rest at home and focus on what was most important: healing.
If you qualify for both Medicare and Medicaid, you may be eligible for an Aetna® Dual Eligible Special Needs Plan (D-SNP).
If you're 65 or older and have diabetes or an eligible heart disease, you may qualify for an Aetna Chronic Condition Special Needs Plan (C-SNP). C-SNPs are currently available in select counties in IL and PA.
You may be eligible for an Institutional Special Needs Plan (I-SNP) if you’ve lived (or plan to live) in a participating facility for 90+ days or you have Medicare Part A (hospital insurance) and Part B (medical insurance).
*FOR HEART AND KIDNEYS SOURCE: Mayo Clinic. Hyperglycemia in diabetes. August 20, 2022. Accessed September 21, 2024.
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
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This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes.
The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. Member name(s) and other details have been omitted or fictionalized to protect the member’s (members’) identity(ies). For more information about Aetna plans, refer to our website.
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