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Resources for navigators and assisters

Consumers need your help to make sense of the Affordable Care Act (ACA) and their health plan options. We’re here to help you.

More coverage areas to serve more consumers

More coverage areas to serve more consumers

Choose an area below to explore state-specific highlights, local network coverage, expanded footprint details and more — like our plan brochure and market summary.

Provider lookup

 

Search our national network of primary care doctors, specialists and hospitals. Plus, many local walk-in cliniclocations.

 

Next, we’ll take you to our directory of health care professionals. Log in if you’re already a member, or choose “Continue as a guest” to find a medical provider in your local area for plan year 2023.

 

Medication finder

 

It's easy to find covered prescription drugs and other important pharmacy coverage details.

More coverage details

 

Medical exceptions

 

In certain cases, you or your prescriber can request a medical exception to the precertification, step therapy or quantity limits requirements or for a drug that’s not covered on your plan. This can be requested on or after the effective date of your coverage. Standard coverage decisions will be made within 72 hours of the initial request. You can ask for your request to be expedited. Expedited coverage decisions are made within 24 hours. We’ll then contact you or your prescriber with our decision. All medically necessary outpatient prescription drugs will be covered. If a medical exception is approved, you will only need to pay the copay after your deductible, if any, is met. This amount is based on your pharmacy plan design.

 

To submit a medical exception request for a noncovered drug, providers have these options:

 

  • Submit their request through our secure provider website on www.availity.com.
  • Call the Pharmacy Precertification Unit: Non-Specialty 1-800-294-5979 (TTY: 711) or Specialty 1-866-814-5506 (TTY: 711).
  • Fax the completed request form to: Non-Specialty 1-888-836-0730 or Specialty 1-866-249-6155.
  • Mail the completed request form to: Medical Exception to Pharmacy Prior Authorization Unit 1300 East Campbell Road Richardson, TX 75081

Under health care reform, you can get some drugs and products with no member cost share. This means they are covered 100 percent by your plan. This list shows some common examples.

 

Preventive drugs and products - 2023 (PDF)

Under health care reform, you can get some drugs and products with no member cost share. This means they are covered 100 percent by your plan. This list shows some common examples.

 

Preventive drugs and products - 2022 (PDF)

 

Maintenance Choice drug list includes drugs a person takes regularly to treat chronic conditions. For instance, arthritis, asthma, diabetes or high cholesterol. Check your plan benefit documents for details on filling a 90-day supply of drugs on this list.

 

Maintenance Medicine List (PDF)

 

Helpful resources

We’re here to help

 

Call your navigator support team


Our dedicated representatives are here to answer all your questions.
 

1-844-383-6125 (TTY: 711)

Call us Monday — Friday, 8 AM to 8 PM ET.

 

*For a complete list of participating walk-in clinics, use our provider lookup. Includes select MinuteClinic services. Not all MinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventative MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states.

For TX/GA: Includes select walk-in clinic services. Not all walk-in clinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventative walk-in clinic services at no cost-share.

Legal notices

Health plans are offered or underwritten or administered by Aetna Health of California Inc., Coventry Health Plan of Florida, Inc., Aetna Health Inc. (Florida), Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna is part of the CVS Health family of companies.

Health benefits and health insurance plans contain exclusions and limitations.