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Aetna fitness reimbursement

Aetna has expanded their commitment to wellness by adding the Aetna fitness reimbursement benefit to some of their MAPD plans.  This benefit provides members of participating plans an allowance for activities or equipment for things such as; golf, pickleball, swimming, running, or even entrance fees for state and national parks.  Members can also use the benefit for fitness equipment such as athletic shoes, exercise mats, weights, wearable fitness trackers or any other equipment that helps them stay healthy.

Please note; this benefit does not cover expenses for fitness attire other than shoes.

Watch a quick video on Medicare advantage plans vs Medicare supplements

More about this benefit

Once the calendar year ends, you cannot roll over any portion of this benefit allowance.  This is a (DMR) direct member reimbursement, this means the member pays for the qualified item or activity up front and then submits the paid receipt to Aetna for reimbursement. Please make sure all fields are completed and receipts included before you send in the request to avoid delays in payment receipt.
If you are unsure if your plan offers this benefit,  either check the Evidence of Coverage for your specific plan or contact your broker to confirm this benefit as well as any other plan questions you have.

Learn the pros and cons of Advantage plans

Please note:  Members do not use the Fitness Reimbursement Form for reimbursement of benefits other than; fitness activity fees, or fitness supplies or wearable items.  Reimbursements  of any other expenses require a specific form for that purpose.

To determine if you should send in an item for reimbursement, make sure you can answer yes to the following 3 questions:

1.  Did you purchase this item or service this year to use this year?
2.  Is the item or service for your benefit/use only?
3. Do you have an itemized receipt for the items or services you are requesting the reimbursement for.  Please make sure the receipt includes the date of purchase, name of retailer, location of retailer and a description of the item as well as the amount paid.

How this benefit works

1.  The member pays up front for the qualified fitness-related services, activity fees or supplies from licensed provider or retail store.  They collect a detailed receipt that contains costs, date of purchase and payment method.
2. Plan member makes the request for reimbursement.  This can be done online at AetnaMedicare.com/Reimburse, once you are on the site, just follow the prompts and fill out the required form and upload a copy of your paid receipt.  If you do not want to fill it out online, you can either print out a copy from the website or request a form from the member services number on the back of your plan ID card. Please see below for more ways to submit your reimbursement.
3. Wait for your reimbursement to arrive.  Aetna will send members a check to reimburse them for qualified purchases.  Please allow up to 45 days to receive your payment.  Aetna must receive both the form and receipt within 365 days of the original purchase.  Allowance amounts do not roll over to the next calendar quarter or plan year.

To download a copy of the Fitness Reimbursement Form, click here

How to request the reimbursement

1. Members can go to AetnaMedicare.com/Reimburse or scan the QR code in this flyer.
2. You can either complete the form online or download, print and complete the reimbursement form and mail it to the claims address found on the back of your member ID card.  If you are requesting the reimbursement by mail, you should make a copy of your original documents; Aetna will not return them to you.

Please note:  any item you purchase from private, non-retail seller will not be accepted for reimbursement.  Plan members should always check their EOC for a full description of plan benefits, exclusions and limitations.

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Aetna SilverScript

For Medicare beneficiaries who are on Original Medicare or Original Medicare and a Medicare Supplement plan, it is a good idea to add a Medicare prescription drug plan to cover your prescriptions. One prescription drug plan that provides coverage to many beneficiaries is the Aetna SilverScript Plan.  In this post, we will go over some of the benefits these plans provide.

Aetna SilverScript Overview

Aetna SilverScript is a Medicare prescription drug plan provider.  It is part of the Aetna family of medical insurance plans. These plans are designed to work with Original Medicare or Medicare supplement plans and cannot be sold to anyone who is currently enrolled in a Medicare Advantage plan and wants to remain on that plan.

Eligibility for prescription plan enrollment

In order for a beneficiary to eligible for enrollment in any PDP plan, they must be enrolled in either Medicare Part A or both Medicare Part A & Part B.  Beneficiaries must also live in the service area of the plan they want to enroll in.

There are specific times you must use to enroll in a Medicare prescription drug plan (Part D).

1. During your initial enrollment period (IEP).
2. Enroll during the Annual Election period (AEP).
3. If you have a Medicare Advantage plan, you can enroll during the Medicare Advantage Open Enrollment Period (MAOEP).
4. When you qualify for a special election period (SEP).

Learn more about Medicare’s enrollment periods

Aetna SilverScript plans

In 2024, Aetna is offering 3 different plan choices:

1. First, the SilverScript Smart Saver plan – This plan has an average monthly premium of $11.19, Please note, this cost is an average.  Actual cost depends on the service area. This plan offers a $0 copay for a 30-day supply of Tier 1 drugs.   There are almost 600 drugs that fall into Tier 1 and Tier 2 on this plan, drugs on tier 2 have a copay amount of $5.  The SilverScript Smart Saver plan also provides members a low deductible of $280 for Tier 2 through Tier 5 drugs.
2. Second, the SilverScript Choice plan – Members of this plan pay an average monthly premium of $46.59.  Please note, this cost is an average and the actual cost depends on the service area.  There is a $545 deductible applied to all tiers of this plan.  The copay amount for Tier 1 drugs is $2 while the Tier 2 copay amount is $7.  Beneficiaries who qualify for Extra Help do not have to pay a plan premium.
3. Third, the SilverScript Plus plan – The premium for this plan averages $103.51 although the actual amount varies depending on the service area.  This is a top-notch plan that offers members a $0 deductible for both Tier 1 and Tier 2 drugs.  On this plan, there is a $0 copay for many prescription vitamins, minerals and some other types of drugs. members also receive additional gap coverage.

Watch a video on Drug plan changes for 2024

Features of Aetna SilverScript PDP plans

Variety of Plans

Aetna offers a wide range of prescription drug coverage options.  This allows beneficiaries to choose a plan that aligns with their personal needs and budget.  Each plan covers different medications at varying costs.

Extensive Network of Pharmacies

All Aetna SilverScript plans offer an extensive network of pharmacies.  This gives beneficiaries the flexibility and convenience to choose where they fill their prescriptions.

Mail-Order Options

The Aetna SilverScript plans provide the option for mail-order prescriptions, allowing beneficiaries to receive a 90-day supply of their medications conveniently delivered to their door.

Members of Aetna SilverScript PDP plans can visit AetnaMedicare.com to access and print plan materials, pay their plan premiums, check coverage of their drugs or locate a local, preferred pharmacy.

Aetna also provides members a secure site, Caremark.com, to find prescription prices, see possible prescription savings options, sign up for mail delivery, check order status and more.

Click here to learn why you should use a Medicare agent

To see if these plans are right for you, check with a licensed Medicare agent who can ensure your coverage needs are properly met by either these plans or another one.

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Aetna Medicare OTC catalog 2024

Both current members and anyone considering enrollment in an Aetna MAPD plan should take a look at the benefits in the Aetna Medicare OTC catalog 2024.

Aetna has two separate catalogs for 2024.  The first one is for members of their participating MAPD plans, this catalog is called Over-the-Counter Health Solutions (OTCHS).  There are three ways to order products from the OTCHS.

Download the MAPD OTC catalog 2024

Order in a participating CVS pharmacy

Use the following link to find a participating store:  CVS.com/storelocator.

Please note:  CVS pharmacies inside either Target or Schnucks stores do not participate in the OTCHS program.

1. Look in your OTC catalog to find items you would like to purchase.  It is important to know; only items in the catalog are available to purchase with this plan.
2. Locate products marked with the blue shelf tag in the store.  Prices of in store items may not be the same as the catalog price.
3. Use your benefit at any register.  Tell the cashier you have the OTC benefit and show them your member Id card to verify your eligibility.

Use the OTC Health Solutions app to access OTCHS benefits

Download the app from either the App Store (for apple devices) or from Google Play (for Android devices). Look below for three easy steps to use the app in stores.

1.  Scan the item’s barcode to make sure it is an approved item (eligible items should have a blue tag).
2. When you are ready to check out, show the cashier the digital barcode from your phone.
3. Use the app to check on your remaining benefit balance or get answers to some FAQs.

Order items online

Create an account by visiting CVS.com/otchs/myorder.

1. Click on the create account button and follow the prompts.  Please note:  you will need your member ID, birthdate, zip code and a valid email address.
2. Sign into your account and view your available benefit amount as well as products.
3. Add products to your cart and then click checkout.  Confirm your shipping address, review your items and place your order.
4. You will receive an email with tracking information.  Items will arrive in about 14 days.

Order items over the phone

1. To place an order, call 1-833-331-1573 (TTY:711).
2.   You must enter your birthdate to verify your account.  You will also need to verify your name and address.
3. Please have the code for the items you wish to order.  If the code is A10, just enter the numerical code 10.  After your items is located in the system, you verify it is correct.
4. Once you finish your order, you can review items and submit the order.

The second catalog is for Aetna DSNP plan members:

Download the Aetna DSNP OTC catalog 2024 Nations benefits

The catalog for DSNP members is referred to as Nations Benefits.  There are 3 ways to order items from the Nations Benefits catalog,

order by mail

Members receive an order form in their Nations Benefits catalog.   Fill out the form provided and mail it to: NationsBenefits, 100 N. University Drive, Plantation, FL 33322.

Order online

Go to Aetna.NationsBenefits.com

1. create an account by following the instructions on the page.
2. Once you are logged in, you can search for items, read product descriptions and check your benefit balance.
3. Place items in your cart.
4. You will receive an email so you can track your items.  You should receive your order in about 14 days.

Order by phone

Call 1-877-204-1817 (TTY: 711).   Speak with a member experience advisor from 8AM – 8PM, local time 7 days a week, except for holidays.

Please note: Language support is available if needed.

All beneficiaries should be aware:

Because of the personal nature of the items, there are no returns or exchanges.  Please call OTC health solutions within 30 days of receipt if you receive a damaged item.

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Aetna OTC 2023

Medicare Advantage clients who are members of an Aetna plan this year may want Aetna OTC 2023 information.  This year Aetna is providing 3 different OTC catalogs for members from different Medicare Advantage plans.  The catalog choices are for either the DSNP, National (Eagle Plan) or the Value, this catalog covers all other participating MA plans.

DSNP OTC 2023 catalog

Aetna Explorer Plan 2023 OTC catalog

Aetna OTC catalog 2023 for Value & all other plans

There are 5 different ways to place an OTC order:

Purchase items in-store

Use your Extra Benefits Prepaid Card at a nearby participating stores.  Find a retail location at Aetna.NationsBenefits.com or by calling NationsBenefits at 1-877-204-1817.
You will find an in-store shopping guide either in the OTC catalog, online at Aetna.NationsBenefits.com or by scanning the UPS barcode on a product with the app.  The UPC barcode is a series of black, vertical lines you will find on a product.

In order to scan the UPC code with your cellphone, you need to open the MyBenefits app on your phone and launch the barcode scanner.  Once you have the scanner opened, you can put your phone’s camera over the barcode and then scan  it.  At that point, you will the product eligibility information.  When you are ready to check out, just choose debit and swipe your card.  You do not need a PIN number.  In the event that your total is more than your available OTC balance, you need to use another form of payment to complete the sale.

Place your order Online

To purchase goods online, log in to your secure online account on the MyBenefits website at Aetna.NationsBenefits.com, select the items you wish to purchase ad follow the instructions for checkout and payment.  Aetna Nations Benefits will then ship the items to your home at no charge.

Use the free App

To use the free app, the first thing you do is download the MyBenefits app.  You can do this by either scanning the QR code in the OTC catalog or at the App Store on apple devices or on Google play on Google devices.  Once you have installed the app on your phone, you can choose the items you want to buy and then follow the instructions to checkout and pay.  The items  ship to you for free.

Order by Phone

Find the items you want to purchase in the OTC catalog and call 1-877-204-1817 (TTY: 711) to place your order.  Member advisors are available to assist you 24 hours a day, 7 days a week, 365 days a year.

Place an order by Mail

Use the catalog to Select the items you want to buy and then complete the order form that you find in the back of the OTC catalog.  You will also find a postage paid envelope in the back of yoru catalog.  Mail the order to:
NationsOTC
1801 NW 66th Avenue, Suite 100
Plantation, FL 33313
Each catalog only includes one order form.  You will receive a new order form with each order.
Please remember:  any un-used OTC benefit expires at the end of each quarter.  Please be sure to place your order no later than; 3/20/23 for the first quarter, 6/20/23 for the second quarter, 9/20/23 for the third quarter and 12/20/23 for the final quarter.
Any order placed after these dates will apply to the next quarter’s benefit.

Be aware: any unused allowances do not roll over to the next quarter.

Important information:

Please note; the products in these catalogs are intended for the use of the enrolled member only.

The item cost may not exceed your benefit amount.

There are no reimbursements allowed for any unused benefit amount.

Only items included in the catalog are covered by the OTC benefit.

The OTC benefit limits apply to all channels including retail transactions.

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Aetna Medicare OTC Catalog

This post will give clients who have insurance through an Aetna Medicare plan a clear picture of which items are in the Aetna Medicare OTC Catalog.

For those individuals who have either an Aetna or Coventry Medicare plan, their benefits include an over-the-counter (OTC) benefit.  This benefit allows members to order
approved OTC items every month.

THIS POST HAS BEEN UPDATED; CLICK HERE FOR INFORMATION

Some information about this benefit:

The OTC benefit gives you an easy way to receive generic over-the-counter health and wellness products by mail.
All you need to do is, place an order using the list of approved OTC items and Aetna will mail them directly to your home.  It is that easy.
Here are the program rules:
1.  Clients can place only one order per month.  This can be either less than or equal to their approved benefit amount.
2.  They will receive the generic (non branded) equivalent of all chosen items.
3.  If you do not use the benefits, they will not be rolled over from one month to another.
4.  The items you choose to order are for the members use only.
5.  It is prohibited to order OTC items for use by either family members or friends.

LOOKING TO COMPARE MEDICARE PLANS- call our office at 203-796-5403 or email admin@croweandassociates.com

With this benefit members are able to buy specific, approved generic OTC products.  These products are not covered by either Medicare Part B or Medicare Part D.  It will benefit members to keep this list handy.  If you use this program, it can save you money on certain items that normally you would have to pay out of pocket for.   If you would like to view a copy of the Aetna Medicare OTC Catalog, click the following link:  Aetna OTC Catalog .

There are 2 ways for members to order supplies:

You can order either by phone 1-888-628-2770 (TTY: 711) Monday through Friday from 9a.m. until 5p.m., or you can order online at order.otchs.com.

Aetna Medicare offers members  PDP, HMO and PPO plans with a Medicare contract. Aetna’s SNPs catalog are also contracted with State Medicaide programs.  Enrollment in these plans depends upon contract renewal.  Members can contact their individual plans for more benefit details.  Limitations, co-payments as well as restrictions may apply.  Benefits are subject to change on January 1st of every year.  Plan features as well as availability may differ depending on the members service area.

Agents- Click here for a Medicare Scope of Appointment

QUESTIONS ABOUT YOUR MEDICARE PLAN?  CALL US TO GET THE ANSWERS 203-796-5403 or send an email to teal@croweandassociates.com.

If you would like to get a quote for a Medicare Advantage or Supplement plan, CLICK HERE

Aetna Medicare Plan HMO Connecticut

Aetna Medicare Plan HMO Connecticut is a Medicare Advantage Plan (MAPD).  This plan is  offered in Fairfield, New Haven, and New London counties.  Aetna refers to this plan as the Shoreline plan. They also offer a similar version of it called “inland”.  The inland plan includes Hartford, Litchfield and Tolland counties. The Aetna Medicare Plan HMO Connecticut is an HMO plan. Members must use in network providers (except for emergency and urgent care).  If  you choose to use an out of network provider in an non emergency or urgent care situation, there will be no coverage at all.  Medicare A and B will not provide the standard 80% part B coverage when going out of network on a Medicare Advantage plan.

In addition to a $6,700 maximum out-of-pocket contribution (for medical expenses only), this Aetna plan is a $0 premium offering and requires referrals to see specialists.  You only need to obtain a referral once per specialist each calendar year.  The plan features very low co-pays for a $0 premium plan. With a $10 primary doctors copay and a $40 specialist copay. Most other co-pays are also low compared to other plans offered in the same market such as a $600 inpatient hospital co-pay and a $150 major radiology copay (basically means MRI’s, CAT and PET scans).

The prescription drug plan (included with benefits of plan)

is one of the few that does not have a deductible on tier 3, 4 and 5 drugs.   Overall, this is a solid plan with a large national network of providers that can be accessed anywhere in the country.  The one benefit that should be noted with this plan is the fact that it does have an annual deductible of $1,000 for some services such as Inpatient hospital, major radiology, Outpatient surgery, ambulance and some other services. A plan summary has been provided below for review.

CLICK HERE FOR AETNA MEDICARE PLAN HMO CONNECTICUT PLAN SUMMARY

Click here for a free Medicare review and quote.

 Aetna Medicare Elite Plan Connecticut

We are giving clients some information about the Aetna Medicare Elite Plan Connecticut.  The Aetna Medicare Elite plan is a Medicare Advantage Plan. This plan offers prescription drug benefits in Connecticut in both Fairfield and New Haven Counties for 2015.  This plan replaced the Aetna Medicare Value plan which was available throughout 2014.  Below is an outline of plan benefits along with links to benefits summaries. Read more

Aetna Medicare Plan Changes Connecticut 2015

If you would like to learn about the Aetna Medicare Plan Changes Connecticut 2015, you should read this post.  Aetna Medicare will be making major changes to their Medicare Advantage plans in some Connecticut counties for 2015.  A quick summary of changes is listed below.  Call or email our office for specific information and CMS approved benefit summaries and other info.

• The current Aetna Value HMO

• $0 premium plan will be discontinued in Fairfield and New Haven counties as of January 1, 2015.  This means you will not have a plan as of January 1, 2015.   If you are in this plan currently you must enroll in a different Medicare plan if you want one for 2015.   There is a special enrollment period for this situation.   This allows consumers to enroll in a new plan anytime from December 15th, 2014 through the end of February 2015.

• The Aetna Value HMO

• will still be available at $0 monthly premium to those in Hartford, Litchfield and Tolland counties.  Benefits have some minor changes. They are now going to a $25 primary as well as a $50 specialist copay.   They are also moving the inpatient hospital benefit to $300 for days 1-4.

• Aetna will have a new $0 premium plan called Aetna Elite HMO

• available 1-1-15 for those in New Haven and Fairfield county.  The plan boasts low copays ($10 primary/$35 specialist) and $550 per stay hospital inpatient copay.   HOWEVER, it will have a $1,000 annual deductible for that will apply to major services.  Office visits, preventative benefits, lab and some other benefits will not apply to the deductible and will still be a copay however.
• Aetna will still offer the Standard HMO plan with only small benefits changes and a 2015 premium of $118.00 a month in Hartford, New Haven , Fairfield, Litchfield and Tolland counties.
• Aetna will still offer the Standard PPO plan with only small benefits changes and a 2015 premium of $101.00 a month in Hartford, New Haven , Fairfield, Litchfield and Tolland counties

Please either call or email our office with any additional questions at 203-796-5403 or by email at Admin@croweandassociates.com.

There are 5 companies offering Medicare Advantage Plans (MA or MAPD) in the state of Connecticut.  The 5 companies are Anthem BCBS, Aetna, United HealthCare, Connecticare and Wellcare.  They do not all offer their plans in all counties of Connecticut however.  This post provides an overview of what is available.  Please call or email us for a benefit summary on any of the plans listed below.

WellCare- Offers plans in Fairfield, Hartford and New Haven Counties.  Wellcare has a $0 premium plan that boasts the lowest copays of any $0 premium MAPD in Connecticut.  They also have the only Dual Eligible offering in the state.   Both plans are very strong from a copay and additional benefit standpoint.    Wellcare does have network limitation that need to be considered.  Networks tend to be best in and around cities.  They do not have network in northern Fairfield county.

Anthem BCBS- Anthem offers plans in all counties of Connecticut.  They have an HMO offering for $28 per month.  They also have a PPO (available in limited counties only) for $18.00 that boasts very strong benefits compared to all other PPO plans in Connecticut.   Anthem has a very large network but is missing some major Physician IPA groups in CT.

United HealthCare- United offers plans in all counties of Connecticut.  They have 2 HMO plans ($99 a month plan and $0 a month plan) along with an AARP branded PPO plan for $24.00 a month.   United has an extensive provider network through Connecticut.  The UHC plans do not participate with Quest Labs which should be taken into consideration.  All other major labs do participate however.

Aetna- Currently offer plans in Fairfield, Hartford, Litchfield and New Haven county.  They have a $0 premium plan HMO, $94.00 HMO and a $90 PPO plan.  The $0 premium plan has benefits second only to Wellcare when compared to the other $0 premium plans in the state.  They also have a substantial network to go with the plan and allow for access to any Aetna Medicare HMO provider nation wide.  The Aetna PPO is not competitive at this point due to a $1,000 out of network deductible.

Connecticare- We have a contract with Connecticare but they will not allow to post any comments about their plan.  Call the office if you want information on this company 203-796-5403 or email Edward@Croweandassociates.com

HOW CROWE & ASSOCIATES CAN HELP YOU:

Crowe & Associates is an independent based in Brookfield CT. We are A rated with the BBB and are contracted to sell every Medicare Advantage plan in Connecticut.  We are paid commission from the companies and do not charge clients a fee for our services as a result.  We work with seniors in Connecticut every day to help them find the right Medicare plan to meet their needs.  Feel Free to call our office at 203-796-5403 or email me at Edward@Croweandassociates.com

Would you like to learn More? Register for our “How to choose a Medicare plan” Webinar by clicking this link