Important information about our provider directory This online directory lists Aetna Medicare℠ Plan (HMO) (PPO) network providers. For detailed information about your health care coverage, please see your Evidence of Coverage.

How to find providers in your area The directory tool lets you search for:

• A provider, by entering a ZIP code, county, or city • A provider’s name, facility, specialty or condition • A hospital or urgent-care center You may have to select a product or plan name to complete the search.

About the providers in this directory

The HMO/PPO network providers in this directory have agreed to provide you with your health care services. You may go to any of these network providers. However, some services may require a referral. If you’ve been going to one network provider, you don’t have to continue to go to that same provider. In some cases, you may get covered services from out-of-network providers. For some plans, you may have to choose one of our network providers to be your primary care physician (PCP). (We’ll often use the term "PCP" throughout this directory.) You can also find a list of pharmacies that offer Part B and Part D drugs in your pharmacy directory. Check with your pharmacy to see if they offer the services you need to fill a prescription.

We update provider information regularly

We make updates six days a week, excluding Sunday and holidays. Updates may also be affected by interruptions due to system maintenance, upgrades or unplanned outages.

This information is subject to change at any time

Please contact your provider before you schedule an appointment or receive services. Confirm that they still participate in our network.

For more information

For information on Aetna Medicare℠ Plan (HMO) or (PPO) network providers in your area, just call us at 1-800-282-5366 (TTY: 711). We’re available from 8 a.m. to 8 p.m., seven days a week. You can also get information on http://www.aetnamedicare.com.

What to do if you get a bill from a non-network provider

If an out-of-network provider sends you a bill, don’t pay it. Instead, send it to Aetna Medicare to process it. We’ll determine your cost-sharing amount, if any. Our claims/billing address is on your member ID card.

What is prior authorization and when do you need it? Certain network health care services, such as hospitalization or outpatient surgery, require prior authorization from Aetna Medicare. This means that Aetna Medicare must approve the service before the plan will cover it. Check your Evidence of Coverage for a list of services that require prior authorization. If you need services that require prior authorization, have the network provider contact us. The provider is responsible for getting prior authorization from Aetna Medicare before treating you. Some plans include an out-of-network benefit. If yours does and you decide to receive covered services from an out-of-network provider, ask the provider to contact us for prior authorization for those services.

When you need emergency care

If you need emergency care, you’re covered 24 hours a day, 7 days a week, anywhere in the world. Whether you’re in or out of an Aetna Medicare service area, please follow these guidelines when you think you need emergency care: • Call the local emergency hotline (for example, 911) or go to the nearest emergency facility. • Notify your PCP as soon as possible after you get treatment. • Call your PCP if a delay in treatment would not be harmful to your health. • Notify your PCP or Aetna Medicare as soon as possible if you’re admitted to an inpatient facility.

If you travel outside of the Aetna Medicare Plan (HMO) (PPO) service area

You’re covered for emergency and urgently needed care. You can always get emergency care from the closest available provider, in or out of the service area. HMO plan members must use providers in their network service area for urgent care, unless these providers aren’t available. When you’re out of the service area, you can get urgent care from the first available provider. You can get urgent care from: • A private practice physician • A walk-in clinic • An urgent-care center or an emergency facility We’ll review the information that the provider who supplied your care submits to us. We may need additional information if the nature of the urgent or emergency issue doesn’t qualify for coverage.

Follow-up care after an emergency

Your PCP should coordinate all follow-up care. For HMO plans, we may cover follow-up care with outof-network providers if you meet these two requirements: 1. Your PCP’s referral 2. Aetna’s prior authorization If your plan requires a referral, you must get one before we’ll cover any follow-up care. This applies whether you were treated inside or outside your Aetna Medicare service area. If your HMO plan doesn’t require a referral, you should call us at 1-800-282-5366 (TTY: 711) before you get follow-up care at out-of-network facilities. We’re available from 8 a.m. to 8 p.m., seven days a week. You can also get information on http://www.aetnamedicare.com. Examples of follow-up care include: • Suture removal • Cast removal • X-rays • Clinic and emergency room revisits We’ll cover in-network and out-of-network follow-up care after emergencies for PPO plans, under the terms and conditions of your plan.

Information for California members only

Aetna contracts with provider organizations called an Independent Practice Association (IPA) or a Physician-Hospital Organization (PHO). An IPA/PHO is an association of independent providers. It may include hospitals, primary care doctors and specialist doctors, who together provide health care services. Aetna uses several IPAs to provide you with health care services. If you choose a primary care physician (PCP) associated with an IPA/PHO, they’ll refer you for health care services and specialist care within their IPA/PHO.

If you’re enrolled in our Aetna Medicare Prime Plan (HMO) or (PPO)

You’ll need to use our dedicated network of local providers. We work closely with them to coordinate your care. If you have the Prime HMO plan, you’ll have to pay for out-of-network care. With the Prime PPO plan, we’ll pay for part of your out-of-network care, but you may pay more out of pocket. If you need urgent or emergency care, or get out-of-area kidney dialysis, we’ll cover it even if the provider isn’t part of the Prime network.

If you’re enrolled in a standard Aetna Medicare Plan (HMO)

You’ll have to choose a primary care physician (PCP). You can find a network doctor in this directory.

Generally, you must get your health care coverage from your primary care physician (PCP) Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.

You’ll need to get a referral from your PCP for covered, non-emergency specialty or hospital care, except in an emergency and for certain direct-access service. There are exceptions for certain directaccess services. You must use network providers, except for: • Emergency or urgent care situations • Out-of-area renal dialysis If you get routine care from out-of-network providers, Medicare and Aetna Medicare won’t be responsible for the costs.

If you’re enrolled in an Aetna Medicare Plan (HMO) Open Access You’re not required to choose a primary care physician (PCP). You don’t need a referral to visit network providers to receive covered services. Although you’re not required to select a PCP, we encourage you to do so. You must use network providers, except for: • Emergency or urgent-care situations • Out-of-area renal dialysis If you get care from an out-of-network provider, your plan won’t cover their charges. Medicare and Aetna Medicare won’t be responsible either.

If you’re enrolled in an Aetna Medicare Plan (PPO)

You have the flexibility to receive covered services from network providers or out-of-network providers. Out-of-network/non-contracted providers are under no obligation to treat Aetna Medicare members, except in emergency situations. For a decision about whether we’ll cover an out-ofnetwork service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call us or see your Evidence of Coverage for more information, including the cost share for out-of-network services. Although you don’t have to choose a primary care physician, we encourage you to do so. If you receive covered services from an out-of network doctor, it’s important to confirm that they: • Accept your PPO plan • Are eligible to receive Medicare payment

The service area for the Aetna Medicare Plan (HMO) or (PPO)

Please see your Evidence of Coverage for the most up-to-date service area listing.

If you have questions

For questions about your Aetna Medicare Plan (HMO) (PPO) or if you need help selecting a PCP, call us at 1-800-282-5366 (TTY: 711). We’re here from 8 a.m. to 8 p.m., seven days a week. You can also get information at http://www.aetnamedicare.com.

Prime plan members only

Other pharmacies, physicians and providers are available in our network.

Medicare Advantage plan members only

Members who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays.

Accreditation by the National Committee for Quality Assurance

Aetna is committed to accreditation by the National Committee for Quality Assurance (NCQA). It demonstrates our commitment to continuous quality improvement and meeting customer expectations. You can find a complete listing of health plans and their NCQA status at www.ncqa.org. Click on the “Report Cards” tab to search on “Health Plans.” To refine your search, click on “Clinicians” or “Other Healthcare Organizations.” The link for “Clinicians” includes doctors recognized by NCQA in the areas of: • Heart/stroke care • Diabetes care • Patient-centered medical home and patient-centered specialty practice The recognition programs are built on evidence-based, nationally recognized clinical standards of care. Therefore, NCQA provider recognition is subject to change. You can find the official NCQA directory of recognized clinicians at http://recognition.ncqa.org. The link for “Other Healthcare Organizations” includes “Managed Behavioral Healthcare Organizations” for behavioral health accreditation and “Credentials Verifications Organizations” for credentialing certification.

Terms of use By using the provider search directory, you acknowledge and agree that all of the data contained within belongs exclusively to Aetna and is protected by copyright and other law. The directory search is provided solely for the personal, non-commercial use of current and prospective Aetna members and providers. Use of any robot, spider or other intelligent agent to copy content from the provider search, extract any portion of it or otherwise cause the provider search to be burdened with unwarranted high access or transaction activity is strictly prohibited. Aetna reserves all rights to take appropriate civil, criminal or injunctive action to enforce these terms of use.

Disclaimers

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with state Medicaid programs. Enrollment in our plans depends on contract renewal. 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 information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary. To get the most up-to-date information about Aetna Medicare Plan (HMO) or (PPO) network providers in your area, call our Member Services department. The number is 1-800-282-5366 (TTY: 711). They’re available 8 a.m. to 8 p.m., seven days a week. You can also get information from our website, http://www.aetnamedicare.com. Participating doctors, 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. Provider network composition is subject to change. Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

Our dual-eligible Special Needs Plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. Aetna Medicare’s pharmacy network offers limited access to pharmacies with preferred cost sharing in: Suburban New York and Texas; and Rural Maine, Utah and Wyoming. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at http://www.aetnamedicare.com/pharmacyhelp. Read our Notice of Non-Discrimination. ©2016 Aetna Inc. Directory Last Updated 10/01/2016

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