Aetna Better Health is a Medicaid managed care plan, not Medicaid itself
Aetna Better Health is one of many private insurance companies that contracts with state Medicaid programs to deliver coverage. When you enroll in Aetna Better Health, you are still on Medicaid — the state still pays for your care — but Aetna manages your benefits, coordinates your doctors, and handles claims. Whether it is "better" depends on what matters to you: the doctors in their network, the prescription drugs they cover, the out-of-pocket costs, and how easy they are to reach when something goes wrong.
Aetna Better Health operates in multiple states, but the specific plans, covered services, and costs vary by state and sometimes by county. A plan in Florida covers different things than a plan in Ohio. You cannot compare Aetna Better Health to Medicaid as a whole — you compare it to other Medicaid managed care plans available in your state, or to fee-for-service Medicaid if your state still offers that option.
Key Takeaways
- Aetna Better Health is a private company managing Medicaid benefits on behalf of your state, not a separate program or alternative to Medicaid.
- Coverage, copays, and which doctors you can see depend on your state and the specific plan you are in — check your state's Medicaid website for what Aetna Better Health covers where you live.
- You may be able to choose Aetna Better Health during open enrollment, or your state may assign you to it automatically if you do not pick a plan.
- If you have problems with Aetna Better Health — a claim denied, a doctor not in network, a long wait for authorization — you have the right to file a grievance with Aetna and an appeal with your state Medicaid agency.
How Aetna Better Health Medicaid plans work in your state
Your state Medicaid program contracts with Aetna Better Health to cover a set of services for a fixed monthly payment per member. Aetna then decides which doctors, hospitals, and pharmacies are in their network, which drugs require prior approval, and how much you pay at the point of care. You keep your Medicaid card, but you also get an Aetna Better Health card, and you use the Aetna card when you see a doctor or fill a prescription.
The services Aetna Better Health must cover are set by your state — typically doctor visits, hospital care, emergency services, prescription drugs, mental health care, and preventive services. But the details matter: one state's plan might cover dental care and another might not. One might have a $3 copay for a doctor visit and another might have $5. You need to check your state's Medicaid website or call Aetna directly to know what your specific plan covers.
Aetna Better Health is required to cover emergency services even if you go out of network, and they cannot deny you coverage for a service that Medicaid covers just because they do not want to pay for it. But they can require you to use an in-network doctor first, or get approval before you see a specialist.
What to check before you enroll or accept assignment
If you have a choice of Medicaid plans in your state, compare Aetna Better Health to other options using these questions: Is your current doctor in Aetna's network? If not, are you willing to switch? What is the copay for a doctor visit, and does Aetna charge copays at all — some states do not allow them for Medicaid? Which hospitals are in network, especially if you have a condition that requires specialist care?
Check the formulary — the list of drugs Aetna covers. If you take a prescription medication, search for it on Aetna's website or call them to confirm it is covered and whether you need prior authorization (a step where Aetna approves the drug before you fill it). A drug not on the formulary means you either pay out of pocket or Aetna denies the claim.
Look at whether Aetna Better Health covers services you use regularly: mental health visits, physical therapy, dental care, vision care, or transportation to medical appointments. These vary widely by state and plan. If you cannot find the answer on their website, call Aetna's member services number — it is on any materials they send you — and ask directly.
When Aetna Better Health denies a claim or service
If Aetna denies a claim, refuses to cover a service, or will not authorize a specialist visit, you have two paths: a grievance with Aetna and an appeal with your state Medicaid agency. A grievance is a complaint about how Aetna handled something — poor customer service, a lost claim, a long wait. An appeal is a formal request to reverse a coverage decision — Aetna said no to a drug or procedure, and you are asking them to reconsider.
File a grievance with Aetna in writing (email, mail, or through their member portal) and keep a copy. Aetna must respond within 30 days. If you disagree with their response or want to challenge a coverage denial, file a state appeal with your Medicaid agency — the address and process are in your Aetna materials or on your state's Medicaid website. State appeals can take longer but are often more successful because a state official reviews the decision, not Aetna.
If you need a service urgently and Aetna is slow to decide, ask for an expedited review. Aetna must respond within 72 hours for urgent matters. Document everything: the date you called, who you spoke to, what they said, and what you asked for. This record matters if you end up filing a state appeal.
How to learn about Aetna Better Health is available in your state
Aetna Better Health operates in Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Louisiana, Missouri, New Mexico, Ohio, Texas, and Washington, but not all states offer it in all counties. Go to your state's Medicaid website and search for "managed care plans" or "health plans." The site will list which companies operate in your area and let you compare them. You can also call your state Medicaid agency directly — the number is on your Medicaid card or on the state website.
If you are already on Medicaid and your state assigns you to Aetna Better Health, you will receive a notice in the mail explaining the change, your new plan details, and your right to choose a different plan during open enrollment. Open enrollment usually happens once a year, typically in the fall. If you do not want Aetna Better Health, you can switch to another plan or, if your state offers it, to fee-for-service Medicaid.
Frequently Asked Questions
Do I have to pay premiums for Aetna Better Health Medicaid?
No. Medicaid covers the premium — your state pays Aetna a monthly fee to cover you. You may have copays when you see a doctor or fill a prescription, but the amount varies by state. Some states do not charge Medicaid copays at all. Check your plan documents or call Aetna to find out what you owe.
Can I see any doctor I want with Aetna Better Health?
You can see any doctor in Aetna's network without extra cost. If you see a doctor outside the network, Aetna may not cover it, or may cover it at a higher cost. Emergency services are covered out of network. If your doctor is not in network and you want to keep seeing them, ask Aetna about an out-of-network exception — they can sometimes approve it.
What happens if I move to a different state?
Your Aetna Better Health coverage ends when you move. You will need to enroll in your new state's Medicaid program. Some states process this quickly if you report the move, others take weeks. Contact your new state's Medicaid agency as soon as you move to avoid a gap in coverage.
How do I reach Aetna Better Health customer service?
Your member ID card has a phone number for Aetna customer service. You can also visit Aetna's website or log into your member portal. Response times vary, but Aetna is required to answer calls during business hours. If you cannot reach them or are not satisfied with the response, file a grievance with Aetna or contact your state Medicaid agency.
Can Aetna Better Health drop me from the plan?
Aetna can disenroll you only for specific reasons: you move out of state, you no longer meet Medicaid income limits, you request to leave, or you violate plan rules (like being abusive to staff). They cannot drop you because you use too much medical care or cost too much. If Aetna tries to disenroll you, you have the right to appeal the decision to your state Medicaid agency.