Aetna Better Health: What’s New in 2025 and How It Benefits You

Why Aetna Better Health matters

Aetna Better Health sits at the intersection of Medicaid, CHIP, and Medicare-Medicaid programs, providing managed care plans designed to simplify how people access essential services. If you or a family member relies on state Medicaid, Children’s Health Insurance Program, or a dual-eligible plan, this carrier may be one of your options. In 2025, the focus continues to be on member experience, integrated care, behavioral health access, digital tools, and practical support such as transportation and care coordination. Understanding how these plans work—and where they differ by state—helps you make better choices during enrollment and day-to-day care.

The core idea

At its core, Aetna Better Health is a managed care organization that partners with states to deliver Medicaid and related benefits. States contract with plans to manage networks, pay providers, and help members navigate services. That means your exact benefits, copays, and provider network depend on your state’s contract. Still, several features are fairly consistent: a primary care focus, preventive services without cost-sharing (where allowed), behavioral health coverage, pharmacy benefits, and support services like case management and ride assistance for medical visits. Plans also emphasize community-based care for chronic conditions and programs for pregnant members and children.

Who qualifies

Eligibility starts with your state’s Medicaid and CHIP rules. Those can include income-based eligibility for children, pregnant people, parents, and adults, as well as categories for people with disabilities or those needing long-term services and supports (LTSS). Some members qualify for specialized products—such as Medicare-Medicaid Plans (MMPs) or Dual Eligible Special Needs Plans (D-SNPs)—that coordinate both Medicare and Medicaid. If you think you qualify but aren’t sure, the first step is your state Medicaid agency. They determine eligibility and, after approval, often ask you to pick a health plan from a list that may include Aetna Better Health.

What’s new for 2025

The most meaningful updates in 2025 cluster around access, integration, and digital ease:

Expanded telehealth for primary care, behavioral health, and some specialties, with an emphasis on continuity of care so virtual visits link back to your regular doctor.
More coordinated behavioral health services, including substance use treatment, crisis stabilization pathways, and better handoffs between inpatient and outpatient care.
Stronger care management for high-need members—especially those with multiple chronic conditions, frequent hospitalizations, or transitions between facilities and home.
Upgrades to member portals and mobile apps to manage ID cards, find in-network providers, request rides, view claims, track prior authorizations, and refill prescriptions.
Focus on maternal and child health: prenatal support, postpartum follow-up, breastfeeding help, and pediatric well-child visit reminders.
Transportation enhancements in many markets, including same-day ride requests where available and integration with text notifications.
Preventive care campaigns: vaccines, cancer screenings, blood pressure and diabetes checks, and dental visits for children.

Because contracts are state-specific, not every feature will appear the same way everywhere. However, the direction is clear: simpler access, stronger mental health supports, and more help coordinating complex care.

Benefits you can expect

While specifics vary by state, these are common benefits in many Aetna Better Health plans:

Primary and preventive care: annual checkups, vaccines, screenings, and well-child visits.
Behavioral health: therapy, medication management, inpatient and outpatient services, and substance use disorder treatment.
Pharmacy: a covered drug list (formulary), prior authorization rules for certain medications, and mail-order options in some states.
Specialists: referrals may be required, but members can access cardiology, endocrinology, orthopedics, dermatology, and more in-network.
Maternity and newborn care: prenatal visits, ultrasounds as medically necessary, labor and delivery, postpartum care, and newborn checkups.
Dental and vision: often included for children; adult coverage varies by state but may include exams, cleanings, and basic restorative services.
Care management: nurses, social workers, and community health workers who help with appointments, home services, and understanding your benefits.
Transportation: non-emergency medical transportation (NEMT) to covered appointments, with mileage or rideshare where permitted.
Durable medical equipment: items like walkers, CPAP machines, or glucose monitors when medically necessary.
LTSS: for eligible members, home- and community-based services, personal care, and respite.

The most important step is to verify your state’s member handbook, which lays out the covered services, any copays, and contact information for ride scheduling, pharmacy help, and care management.

How networks work

Managed care plans rely on networks of doctors, hospitals, clinics, therapists, and pharmacies. Access is best when you pick a primary care provider and stick with in-network facilities. Out-of-network services usually aren’t covered, except for emergencies or when prior authorization confirms there’s no available in-network option. Aetna Better Health generally provides a searchable directory and a member services number to help you find a provider who accepts new patients. If you have a specific specialist you prefer, confirm they participate and ask your PCP’s office to help with referrals if your plan requires it.

Prior authorization and referrals

Many plans use prior authorization for certain services or medications to ensure they’re medically necessary. That can include advanced imaging, some specialty drugs, and planned hospital admissions. Your doctor’s office typically submits the request, but it helps to ask about timelines before scheduling. If your plan requires referrals for specialists, build in a few extra days so paperwork doesn’t delay care. Keep notes—date you called, who you spoke with, and what was approved—so you can follow up confidently.

Pharmacy coverage

Aetna Better Health uses drug lists organized by tiers and therapeutic classes. Generics are usually favored, and step therapy may apply, meaning you try a preferred drug before moving to a non-preferred option. If your medication isn’t covered or requires special approval, your provider can request an exception with clinical documentation. Pharmacies in the plan’s network can tell you if a prescription needs prior authorization. Mail-order pharmacy can help with long-term maintenance meds, if available in your state’s plan, and some apps let you set reminders for refills.

Behavioral health access

Behavioral health has moved to the foreground. Plans often cover counseling, psychiatry, intensive outpatient programs, and medication-assisted treatment for opioid use disorder. In many states, crisis lines and mobile crisis teams are integrated with plan coordination, meaning if you or a loved one is in crisis, help can connect quickly to follow-up services. Teletherapy has expanded, but if you prefer in-person care, call member services to find nearby clinics and confirm wait times, which can vary. If you’re transitioning from inpatient to outpatient care, ask for a warm handoff appointment within 7 days to reduce the risk of readmission.

Maternal and child health

For pregnant members, early prenatal care matters. Aetna Better Health programs often include nurse case managers, nutrition counseling, smoking cessation support, and connections to community doulas or lactation educators where available. After delivery, check postpartum coverage timing—many states emphasize a comprehensive visit around 6 to 12 weeks, with depression screening and blood pressure checks. For babies and children, keep up with well-child visits, immunizations, dental checkups, and vision screenings. The plan may offer rewards for completing these visits; ask member services about current incentives.

Chronic condition support

If you manage conditions like diabetes, COPD, asthma, heart failure, or kidney disease, ask about disease management programs. These programs provide personalized coaching, home monitoring support, and help with medication adherence. For diabetes, this might include test strips, glucose monitors, and nutrition guidance. For heart failure, plans may offer weight monitoring, home health visits, and quick follow-up after hospital stays. If you’ve had an emergency department visit, you may qualify for short-term intensive case management to stabilize medications and follow-up appointments.

Long-term services and supports

Members who qualify for LTSS can receive home- and community-based services that help them remain at home safely. That might include personal care attendants, home-delivered meals, adult day health services, and respite for caregivers. Eligibility and service limits are determined by state assessments. If you think you or a family member needs these services, request an assessment through the plan’s care management team. Document daily needs—bathing, dressing, mobility, meal preparation—so the assessment reflects the true level of support required.

Transportation basics

Non-emergency medical transportation is a lifeline for many members, covering rides to doctor visits, dialysis, therapy, and sometimes pharmacy pickup. Each plan sets rules for booking—some allow app-based scheduling, others require phone calls 24 to 72 hours in advance. Same-day rides may be possible for urgent needs. Keep appointment details handy and ask about mileage reimbursement if you have a friend or family member who can drive. If a ride no-shows, call the transportation line immediately; many plans can dispatch a backup.

Digital tools

Member portals and apps continue to improve. Typical features include viewing or downloading your member ID card, searching providers, checking prior authorization status, messaging care teams, and managing prescriptions. Enable notifications to get reminders for vaccines, well visits, and refills. If you prefer paper, you can still request mailed handbooks and provider directories. For accessibility, many materials are offered in multiple languages, and interpreter services are available for calls and appointments at no cost.

Costs and copays

Many Medicaid members have no premiums and minimal copays, though some states use small copays for certain services or prescriptions. There is no cost-sharing for emergency care in emergencies, and preventive services are often covered with no copay. If you have questions about a bill, call the number on the back of your card. Sometimes providers bill before claims are processed, or a service is miscoded. Appeals and grievances exist to challenge denials or resolve problems; ask for help from care management if you need it.

Choosing a PCP

A strong primary care relationship pays off. Pick a PCP who is accepting new patients, is convenient to your home, and has good communication. If you have a chronic condition, look for a practice with care coordinators or integrated behavioral health. If language is a barrier, request a provider who speaks your language or ask for an interpreter. Bring your medication list to the first visit and set one or two goals: better blood pressure control, fewer asthma flares, or a plan for managing anxiety. Follow-up in 4 to 8 weeks to see what’s working.

When to seek urgent or emergency care

Use urgent care for same-day needs like minor infections, sprains, or rashes when your PCP isn’t available. Use the emergency department for severe chest pain, trouble breathing, signs of stroke, major injuries, or a mental health crisis. After any ER visit, call your PCP or the plan’s nurse line to schedule follow-up within a week. Many readmissions and complications are preventable with timely follow-up.

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Appeals, grievances, and your rights

If a service is denied or reduced, you can file an appeal. Deadlines matter, so read the notice and act quickly. Keep copies of letters and ask your provider for supporting medical notes. If you’re unhappy with a provider or a service issue—like repeated ride no-shows—file a grievance. Plans are required to review these and make improvements. You also have rights to language assistance, privacy, and a fair hearing through your state if an appeal isn’t resolved to your satisfaction.

The future outlook

Looking ahead, the future of Aetna Better Health revolves around three themes:

Integrated whole-person care that links physical, behavioral, and social needs.
Community partnerships that address food, housing stability, and transportation gaps.
Data-driven insights to spot care gaps early and personalize outreach.

Expect more collaboration with community-based organizations, expanded home-based services for complex members, and continued telehealth flexibility alongside better in-person access. As states renew contracts, you’ll likely see added accountability for appointment wait times, network adequacy, and member satisfaction.

Practical steps to get started

Confirm eligibility through your state Medicaid or CHIP program if you haven’t already.
Compare available plans in your area, noting provider networks and extra services you value.
Pick a primary care provider and schedule a new patient visit within 60 days.
Download the member app if available and set up notifications.
Ask for care management if you’ve had a recent hospitalization, live with multiple chronic conditions, or are pregnant.
Learn the rules for transportation and prior authorization so surprises are less likely.
Keep a simple health file: ID card, medication list, recent test results, and appointment notes.

Common pitfalls to avoid

Waiting to pick a PCP, which can delay referrals and routine care.
Assuming all providers take your plan—always verify before the visit.
Skipping follow-ups after hospital or ER visits; this is when complications are most likely.
Running out of medications because a refill needed prior authorization; request renewals a week early.
Not using available supports—transportation, care managers, interpreter services, and disease management can make care easier.

Final take

Aetna Better Health is built to make Medicaid and related coverage more usable: stronger primary care, clearer behavioral health pathways, pharmacy support, and practical services that remove barriers like transportation and language. The latest improvements emphasize a more human, connected experience—so members spend less energy navigating the system and more time getting the care they need. If you keep your information current, build a relationship with your PCP, and lean on the plan’s support teams, you can get real value from the coverage.

FAQs

Is Aetna Better Health the same as regular Aetna?

Aetna Better Health is Aetna’s Medicaid-focused brand. It serves Medicaid, CHIP, and some dual-eligible members, and benefits vary by state. Commercial Aetna employer plans are different.

Can I keep my current doctor?

Yes, if your doctor is in-network. Always check the provider directory or call member services before your visit. If not, ask about alternatives nearby or how to switch PCPs.

What costs should I expect?

Many Medicaid members have $0 premiums and low or no copays, but this depends on your state and eligibility group. Preventive care is typically covered without a copay.

Are my prescriptions covered?

Most common medications are covered if they’re on the plan’s formulary. Some drugs need prior authorization or step therapy. Your pharmacy or doctor can help request exceptions.

What if my service is denied?

You can appeal. Read the notice for deadlines, gather your doctor’s notes, and submit the appeal promptly. If needed, you may also request a state fair hearing.

Sources used

State Medicaid and CHIP program standards and member handbooks, which define eligibility, covered benefits, and managed care rules in each state.
Publicly available plan materials from Aetna Better Health describing benefits, care management, behavioral health services, transportation policies, and member rights.
Federal guidance from agencies that oversee Medicaid managed care, outlining requirements for access, appeals, and network adequacy.

Note: Because benefits and rules vary by state, always check your specific Aetna Better Health member handbook or call member services for the most accurate, current details for your plan.