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What’s
covered?
This is Maryland HealthChoice coverage. As a member, you’ll enjoy benefits and services that can help you reach your health goals. To learn more, check your member handbook:
The Aetna Better Health® difference
You deserve to be as healthy as you can be. That’s why we offer the support and tools you need to be your healthiest, bringing together what matters most to your health. It’s care you can trust. And experience you can count on — with extra benefits that go beyond your standard health coverage.
Check this booklet for a complete list of benefits:
Support for monthly periods
If you’re between ages 10 and 55 and you have monthly periods, you can get a variety of menstrual period-care supplies and products. And we’ll send them to you every month at no extra cost.
Maternity Matters® pregnancy and newborn care
Are you pregnant or planning to start a family? We can help you and your child stay healthy during your pregnancy. We'll help you get the care and services you need and you can earn rewards for making healthy choices, including:
$75 gift card for prenatal and postpartum visits
$10 gift card for dental visits
Baby diapers: If you’ve recently had a baby (birth to 24 months of age), you can also get a supply of diapers. We’ll send them to you every month at no extra cost.
Baby diapers
Baby diapers: If you’ve recently had a baby (birth to 24 months of age), you can also get a supply of diapers. We’ll send them to you every month at no extra cost.
Kids’ programs
If your child needs more support in or outside school, we can help:
Ted E. Bear, M.D.® kids club: This program can help you pay for your child’s annual Boy Scouts or Girl Scouts membership. Not a scout? That’s OK. Kids (ages 2 to 18 years) can also get up to $60 per year toward a membership at their local YMCA®.
Sports programs: We’ll also help cover fees for some sports activities and weight management programs.
School uniforms: Does your child need school uniforms? Kids (in 1st through 5th grade) who are up to date on health screenings and wellness visits can get three sets of uniforms.
Care for chronic conditions
Remote patient monitoring program: If you have a chronic condition like diabetes, congestive heart failure (CHF) and/or chronic obstructive pulmonary disease (COPD), you may benefit from this program. Through secure video on your mobile device, you can meet with a nurse from the comfort of home. You and your nurse will take part in daily sessions to help you learn how to better manage your condition.
Carpet cleaning services: Members with asthma and/or COPD can also receive 2 carpet cleanings per year.
Want to learn more? Just call us at 1-866-827-2710 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.
Support for loneliness
Dealing with loneliness? The Pyx Health® app can help. You can connect with a friendly, non-judgmental chat robot named Pyxir. The chat robot is a good listener who offers support, jokes and links to other people and support services. It can also help you find resources for things like food, diapers, rides and more. The Pyx Health app is free and you can use its services 24 hours a day, 7 days a week.
More about Pyx Health
MyActiveHealth SM
MyActiveHealth is a free tool that can help you manage and improve your overall health. You'll get coaching, insights, videos and more to help you reach your health goals.
Learn more about MyActiveHealth
Learn more about MyActiveHealth
Teladoc® telehealth services
Through secure video on your computer, you can meet with a doctor for treatment of common health conditions. Cold or flu? Great reasons to use telehealth. You can also get help with allergies, sinus problems and more. To learn more about Teladoc, just call 1-855-835-2362 (TTY: 711).
Benefits included in your plan
Learn about all your plan benefits, from vision and dental care to telehealth, maternity care and mental and behavioral health care. You can learn more about all these topics in your:
Medical care
At Aetna Better Health of Maryland, we take care of the whole you. So no matter where you are on your path to better health, we’ve got your back. That means you’re covered if you need to see a specialist, have an emergency or are planning to start a family. We also offer a wide range of preventive care services and vaccinations. You can get started by finding a provider today.
Dental care
Dental care is an important part of your overall health. Dental services are provided by the Maryland Healthy Smiles Dental Program. Visit member.mdhealthysmiles.com or contact Maryland Health Smiles member services at team at 1-855-934-9812 for assistance with finding a dental provider near you
Vision care
Keep your eyes healthy with routine eye exams. We work with Superior Vision to provide you with vision care benefits. Your coverage includes:
- An annual vision exam
- Frames and lenses (for members up to age 18)
- $200 per year toward glasses and contacts (ages 19 and up)
To learn more, just call Superior Vision at 1-800-879-6901 (TTY: 711). You can call Monday through Friday, 8 AM to 9 PM.
If it’s late at night or you can’t reach your primary care provider (PCP), you’re not alone. You can speak with a nurse about your health care questions 24 hours a day, 7 days a week. Not sure if you should find urgent care or go to the emergency room? The Nurse Line can help. It doesn’t take the place of your PCP, so be sure to follow up later.
Just call us at 1-866-827-2710 (TTY: 711). Then, choose the option for Nurse Line.
We make it easy for you to get the medicine you need to feel better.
Effective May 1, 2024, a change to your pharmacy benefits will include a copay for prescriptions as directed by Maryland Medicaid. For more information please visit our news & updates section.
A formulary is a list of covered medications. If you don’t see your medicine on our formulary, your doctor will help you find one that is similar. And you can fill your prescription at any pharmacy in our network.
Learn more about pharmacy benefits
You deserve to be healthy in body and mind. Your plan covers health for you as a whole person. That includes help with your mental health or with substance use. You or your child can go to any behavioral health provider in our network.
You can get a variety of mental health services. And other great benefits that extend to people who need:
Counseling
Substance use disorder services
Inpatient mental health
Mental health drugs
You can use your behavioral health benefits by calling Optum Health at 1-800-888-1965 (TTY: 711). Questions? You can call us at 1-866-827-2710 (TTY: 711).
Help in a crisis
Call 911 or go to the nearest hospital if:
You have thoughts of harming yourself or someone else
You have an emergency and need help right now
You can also call or text 988 to reach the 988 Suicide & Crisis Lifeline.
Do you need help getting care? Our care management team is here for you. Care managers are nurses and social workers who understand your health conditions and help connect you to the right care. A care manager can teach you more about your health, help you find a ride to your health care visits and more.
Some diseases call for a little extra care. Our disease management program can help you. Our care managers can help you manage chronic conditions, like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.
If you’re expecting a child, we can help you stay healthy during your pregnancy. Our programs will help you get the care and services you need, every step of the way. You can learn more about pregnancy and newborn care. You can also call us at 1-866-827-2710 (TTY: 711).
Diabetes can be a lot of work to handle alone. Our program can help you manage your blood sugar. You can go to group meetings and learn more about eating healthy, exercising and dealing with stress.
To join, you must be at least 18 years old and:
- Be overweight (have a body mass index of 25 or more, or if you’re Asian, have a body mass index of 23 or more)
- Have been diagnosed with prediabetes
- Have been diagnosed with gestational diabetes
- Not be pregnant
- Have never been diagnosed with type 1 or type 2 diabetes
If you think you qualify for our Diabetes Prevention Program, you can email our Wellness and Prevention Coordinator.
If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency.
Nonemergency medical rides
If you don’t have a ride to your appointment, we’ll help you get one. These rides are for medical services, like:
- Doctor visits
- Dental or vision care
- Behavioral health care
- Pharmacy
First, check with your local health department to see if they cover these rides. If they don’t, just call us at 1-866-827-2710 (TTY: 711). You’ll want to call at least 72 business hours before you need a ride.
It’s important to stay in contact with your health care team. And to be able to receive health tips and reminders by text. Need a smartphone? You can get one through Assurance Wireless® Lifeline at no cost to you. Your smartphone will include services, like:
- Unlimited texts
- 1,000 talk minutes
- 4.5 GB of data each month, all on the T-Mobile Network
To see if you’re eligible for Assurance Wireless, go to Apply for your smartphone.
Apply for your smartphone
These programs can help you live life as healthy as you can. We have special programs and services to help you get the care you need. And prevent health issues in the future.
Starting January 1, 2024, Maryland Medicaid is expanding gender-affirming health care services. Maryland Medicaid covers medically needed care that upholds the safety, dignity and respect of transgender and gender expansive people. Gender affirming care is for those who need medical care to make their body match their lived gender. “Gender-Affirming Treatments” are considered medically necessary treatments that are consistent with current clinical standards of care prescribed by a licensed health care provider for the treatment of a condition related to the individual’s gender identity.
How do I get care?
To get Medicaid gender affirming services, you must:
- Be enrolled in Medicaid
- Talk to your health care provider about a diagnosis for care.
- Be able to make fully informed decisions and consent to treatment.
What gender affirming services does Medicaid cover?
- Hormone therapy and lab testing
- Voice surgery, therapy and lessons
- Hair removal and transplants
- Fertility preservation services
- Facial surgery
- Top surgery
- Gender affirming surgery
- Preventative care after transition
- Revision or reversal of prior gender-affirming procedures
Please visit Pages - gender-affirming-care (maryland.gov) for more information.
When you visit http://healthymeals.aetna.com/ you will get an option to purchase healthy meal kits ingredients that can be delivered to your home free of cost.
OTCHS benefit lets you purchase $25 of over the counter (OTC) health supplies and products and we will ship to you at no extra cost.
Every May, we come together and continue the tradition of promoting awareness, offering vital resources and education, and advocating for the mental health and well-being of everyone. Mental Health conditions are common, manageable, and treatable.
Medicaid coverage
Medicaid covers some services that we don’t cover. For these services, you don’t have to use a provider in our network. Check your member handbook for a list of these services.
Copays
Members don’t have any copays for the services we cover. You only have copays for medicines. If a provider bills you, don’t pay the bill. Just call us at 1-866-827-2710 (TTY: 711).
Approval for services
Some services need approval, or prior authorization (PA), before you get them. We base all our decisions on whether the service is:
Needed for your health
Likely to help you
Covered
Other language and format needs
Need language help? Just call us at 1-866-827-2710 (TTY: 711). We’re here for you 24 hours a day, 7 days a week. You can get:
Interpreter services at no cost during any service or complaint process, including American Sign Language and real-time oral interpretation
Interpreter services for your health care visit (be sure to call 48 hours before your visit)
Info in another format, like audio, large print and braille
Materials in other languages if your primary language isn’t English
Legal notices
All trademarks are the property of their respective owners.