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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.

This map shows U.S. states with new coverage counties for 2025 and states with existing coverage counties. Go to “List of covered states” to find states with new and existing counties.

States with new counties for 2025

Florida, Illinois, Indiana, Kansas, Missouri, North Carolina, Ohio, Texas

More covered states for 2025

Arizona (Banner|Aetna), California, Delaware, Georgia, Maryland, New Jersey, Nevada, Utah, Virginia – Northern (Innovation Health®), Virginia – Southern

 

Where you can find our plans

 

You can find us in select areas in these states:

States with new counties

  • Florida
  • Illinois
  • Indiana
  • Kansas
  • Missouri
  • North Carolina
  • Ohio
  • Texas

More covered states

  • Arizona (Banner|Aetna)
  • California
  • Delaware
  • Georgia
  • Maryland
  • New Jersey
  • Nevada
  • Utah
  • Virginia – Northern (Innovation Health®)
  • Virginia – Southern
 
 

Get access to trusted doctors, specialists and hospitals

Get access to trusted doctors, specialists and hospitals

Find doctors in our network
 

Search our extensive network of primary care doctors, specialists, hospitals and pharmacies. Plus, local walk-in clinic locations.*

Find a doctor
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It’s easy to check if a drug is covered

It’s easy to check if a drug is covered

Find drug coverage
 

Use our medication finder to look up covered prescription drugs and other important coverage details.

 
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Medical exceptions for non-covered drugs

 

Some drugs may not be covered by your plan. Or have precertification, step therapy or quantity limit requirements. If your doctor prescribes one of these drugs, you may be able to get a medical exception.

 

The prescriber can request a medical exception if:
 

  • You have a health condition that may seriously jeopardize your life, health or ability to regain maximum function

  • You’re undergoing a current course of treatment using a non-covered drug
     

How to request a medical exception
 

Options for prescribers:
 

  • Send a request on the Availity provider portal.
  • Call the pharmacy precertification unit:
  • Fax a request form:
    • For non-specialty drugs: 1-888-836-0730
    • For specialty drugs:1-866-249-6155
  • Mail a request form to: Aetna prior authorization, 1300 East Campbell Road, Richardson, TX 75081.

Once we receive the request, we’ll be in touch with you or your prescriber within 72 hours with a coverage decision. For expedited requests, you’ll get a decision within 24 hours. If your request is approved, you only pay a copay after you meet your deductible, if any.

 

2025 pharmacy coverage details


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

 

Preventive drugs and products (PDF)

 
 

Helpful resources

Health plan basics

Must-know info about what ACA plans cover, plan levels and costs, and more.

Bill pay guidance

Easy ways to pay online, by mail, by phone or at any CVS Pharmacy® store location.

Member website & app

Two handy tools to check claims, compare costs, access ID card and more.

Tools and training

Official Marketplace programs and resources to help you help consumers.

 

Check our service area
Have clients looking for 2025 plans or who qualify to get coverage today? Search your client’s ZIP code to check if our plans are in their area.

 

Questions? We’re here to help.

 

Get in touch with us


Your navigator support team is ready to assist you with all your questions.
 

Contact us

Legal notices

Health plans are offered or underwritten or administered by Aetna Health of California 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, CVS Pharmacy and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health® family of companies.

Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Information is accurate as of the production date; however, it is subject to change.

Health benefits and health insurance plans contain exclusions and limitations.