How to get care from home

You don’t have to leave the warm, cozy comfort of home to talk to someone about your physical symptoms or mental health. As an Aetna® Dual Eligible Special Needs Plan, or D-SNP, member, you are eligible for services that help you take care of your well-being without making a trip to the doctor’s office. Below, learn three convenient ways your plan can help you get the care you need from home.

1. Healthy Home Visit

This covered at-home checkup is a chance to meet with a licensed health care provider to talk about the health services and programs you may need. You can invite one of our trusted licensed health care providers over for a private visit — or connect with them online (via telehealth) instead. During the visit, the provider may:

• Go over your medications
• Screen you for certain health problems
• Share details about your health plan and benefits
• Answer your health questions
• Provide tips for home safety
• Talk about cold, flu and COVID-19 prevention

A Healthy Home Visit doesn’t replace your relationship with your primary care provider (PCP). Instead, the clinician will share the details of the visit with your PCP to help them create the right care plan for you.

To learn more about Healthy Home Visits, call Member Services at 1-866-409-1221 (TTY: 711) between 8 AM and 8 PM local time, seven days a week.

To schedule a Healthy Home Visit, call Signify Health® at 1-800-749-4608 (TTY: 711) Monday—Friday from 7 AM to 7 PM CT, Saturday from 8 AM to 5 PM CT and Sunday from 8 AM to 4 PM CT.

2. 24-Hour Nurse Line

When you need a quick answer to a health question, a registered nurse is available by phone to Aetna® D-SNP members 24 hours a day, 7 days a week. Our staff nurses can 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 speak with a registered nurse, call our 24-Hour Nurse Line at 1-866-409-1221 (TTY: 711). If it’s an emergency, dial 911.

Schedule your next flu shot

It’s a key step toward staying healthy this season, and it’s covered by your plan. Call us at 1-866-409-1221 (TTY: 711) between 8 AM and 8 PM, 7 days a week.

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3. Telehealth

Virtual appointments can be a valuable tool for getting and staying well.

With your Aetna® D-SNP benefits, you can often meet with a health professional via a telehealth appointment. Ask your provider if a telehealth visit is an option.

Telehealth uses two-way video on your computer, tablet or smartphone. You and your provider can talk and see each other even though you are in two different places.

Telehealth appointments are best for:

• Follow-up visits with your provider
• An exam of easy-to-see areas like your eyes or skin
• Common health concerns such as allergies, cold and flu symptoms and prescription refills
• Counseling and other mental health services

To confirm that telehealth is covered by your plan and available with your doctor, call your provider or log in to your secure member website. There you can view your Evidence of Coverage (EOC). Telehealth is discussed in Chapter 4, Section 2. When you make an appointment, be sure to say that it’s a telehealth visit. The costs will be the same as an in-person visit.

Question of the month

Q: “I need to see a doctor in person, but the office is closed. Should I go to a retail clinic, urgent care or the ER?”

A: Each one — retail clinics, urgent care centers and emergency rooms — offers a different level of care and expertise. Understanding the differences in services and costs can help you make the best decision. Here’s a simple overview of where to go and when.

• Retail clinics If you have a cold, sore throat or sprained elbow, a retail clinic might be the most convenient and affordable alternative to a doctor visit. These are usually staffed by nurse practitioners and physician assistants. They can treat minor injuries, diagnose common ailments, give immunizations (such as the flu shot, shingles vaccine and COVID-19 vaccine), and prescribe or refill medications.
   
• Urgent care centers Urgent care centers offer treatment for non-life-threatening injuries or illnesses when your primary care provider’s offices are closed, or you can’t get an appointment. They may have X-ray machines and can be able to treat broken bones and stitch up cuts. You can also go to an urgent care center for symptoms like nausea, vomiting, diarrhea, rashes or fever.
   
• Emergency rooms Emergency rooms offer 24/7 emergency care. The staff there can treat severe, life-threatening injuries and health issues. They can handle symptoms like chest pain, difficulty breathing, sudden changes in mental ability, slurred speech, uncontrollable bleeding, head injuries, sudden loss of vision, seizures and more.

If you are experiencing more severe symptoms, such as sudden numbness or difficulty breathing, call 911.

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. 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. For more information about Aetna plans, refer to our website. 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.

If your plan’s Extra Benefits Card includes roll over, any unused amount will rollover into the next month. The monthly amount can be rolled over through the end of the plan year but will not carry over into the next plan year.

Aetna and Signify Health are part of the CVS Health® family of companies.

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