Directory - Aetna Medicare

■ Durable power of attorney — appoints someoneyou trust to make medical decisions for you.■ Do-not-resuscitate order — states that you don’twant to be given CPR if your heart stops or if youstop breathing.You can create an advance directive in several ways:■ Get an advance medical directive form from ahealth care professional. Certain laws require healthcare facilities that receive Medicare and Medicaidfunds to ask all patients at the time they areadmitted if they have an advance directive. Youdon’t need an advance directive to receive care. Butwe are required by law to give you the chance tocreate one.■ Ask for an advance directive form at state or localoffices on aging, bar associations, legal serviceprograms, or your local health department.■ Work with a lawyer to write an advance directive.■ Create an advance directive using computersoftware designed for this purpose.If you have Medicare coverage and aren’t satisfiedwith the way Aetna handles advance medicaldirectives, you can file a complaint with yourMedicare State Survey and Certification Agency.Visit www.medicare.gov for information on specificstate agencies. Or call the Medicare phone number at1-800-MEDICARE (633-4227). For the hearing andspeech impaired, dial TTY 1-877-486-2048. AdvancedDirectives and Do Not Resuscitate Orders. AmericanAcademy of Family Physicians, March 2005. (Availableat http://familydoctor.org/003.xml?printxml)Transplants and Other ComplexConditionsOur National Medical Excellence Program ® and otherspecialty programs helps you access covered treatmentfor transplants and certain other complex medicalconditions at participating facilities experienced inperforming these services. Depending on the terms ofyour plan of benefits, you may be limited to only thosefacilities participating in these programs when needinga transplant or other complex condition covered.Note: There are exceptions depending on state andfederal Medicare requirements.Prescription DrugsIf your plan covers outpatient prescription drugs, yourplan may include a preferred drug list (also known as a"drug formulary"). The preferred drug list includes alist of prescription drugs that, depending on yourprescription drug benefits plan, are covered on apreferred basis. Many drugs, including many of thoselisted on the preferred drug list, are subject to rebatearrangements between Aetna and the manufacturerof the drugs. Such rebates are not reflected in and donot reduce the amount you pay to your pharmacy fora prescription drug. In addition, in circumstanceswhere your prescription plan utilizes copayments orcoinsurance calculated on a percentage basis or adeductible, your costs may be higher for a preferreddrug than they would be for a nonpreferred drug. Forinformation regarding how medications are reviewedand selected for the preferred drug list, please refer toAetna's website at www.aetnamedicare.com or theAetna Medicare Preferred Drug (Formulary) Guide.Printed Aetna Medicare Preferred Drug Guideinformation will be provided, upon request or ifapplicable, annually for current members and uponenrollment for new members. Additional informationcan be obtained by calling Member Services at thetoll-free number listed on your ID card. Themedications listed on the preferred drug list aresubject to change in accordance with applicable statelaw.Your prescription drug benefit is generally not limitedto drugs listed on the preferred drug list. Medicationsthat are not listed on the preferred drug list(nonpreferred or nonformulary drugs) may be coveredsubject to the limits and exclusions set forth in yourplan documents.Covered nonformulary prescription drugs may besubject to higher copayments or coinsurance undersome benefit plans. Some prescription drug benefitplans may exclude from coverage certainnonformulary drugs that are not listed on thepreferred drug list. If it is medically necessary for youto use such drugs, your physician (or pharmacist in thecase of antibiotics and analgesics) may contact Aetnato request coverage as a medical exception. Checkyour plan documents for details.IV