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What’s covered?
We provide Healthy Louisiana (Medicaid) coverage. You’ll get access to a wide range of benefits and services to help you reach your health goals. For complete info, see our list of covered services:
Covered services – English (PDF)
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.
Maternity Matters®
Are you planning to start a family or expecting a child? We’ll help you stay healthy during your pregnancy. Our programs can help you get the care and services you need. And you can earn rewards for making healthy choices.
$25 for over-the-counter (OTC) products
You should have everything you need to help you feel your best. That’s why we’re working with CVS Health® to give you $25 of over-the-counter (OTC) health supplies and products. And we'll send it to you every month at no extra cost.
Telehealth
Through secure video on your computer, you can meet with a licensed 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.
Help stopping nicotine use
Get coaching and medications to help you quit.
Even more benefits
- Dental care: $1,000 per year toward dental care
- Vision care: $150 each calendar year toward eyewear (frames, glasses, or contact lenses)
- Rewards you can earn: Gift cards for completing certain healthy steps
Benefits in your plan
Benefits in your plan
Learn about all your plan benefits, from vision and dental care to telehealth, maternity care and help stopping nicotine use. You can learn more about all these topics in your list of covered services:
Covered services – English (PDF)
Covered services – Spanish (PDF)
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.
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.
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
We take care of the whole you. That means you’re covered if you need to see a specialist, have an emergency or plan to start a family. You have unlimited visits, so you can see your primary care physician (PCP) as many times as you need to — at no cost.
You can also get a wide range of preventive care and vaccines. Start by finding a provider today.
A healthy smile goes a long way. Dental care is part of your overall health. That’s why you should see your dentist every six months. Your dental benefits cover $1000 per year toward dental care for things like:
- Exam and cleanings (twice a year)
- X-rays (once a year)
- Fillings and extractions (once a year)
We work with DentaQuest to provide adults (ages 21 and over) with dental and oral health care. Children under 21 can get covered services through DentaQuest or Managed Care of North America (MCNA) Dental.
Routine eye exams are an easy way to keep your eyes healthy. You don’t need a referral to see a provider in the network. Just be sure to show your member ID card at every visit.
We make it easy to get the medicines you need to feel better. You may have a copay for those on our preferred drug list (PDL). This is a list of medicines we cover. Don't see yours on the list? Ask your provider to find a similar medicine. And you can fill your prescription at any pharmacy in our network.
We want to help members manage pain in ways that are safe and effective. Talk with your doctor about pain medications other than opioids. Members with chronic pain diagnosis can receive up to $500 per year to use towards:
- Alternative pain management options (ages 16+)
- Three chiropractic visits each year (ages 21+)
Questions about pain management? Just call us at 1-855-242-0802 (TTY: 711).
Your mental health is part of your overall health. So if you need help with mental health or a substance use disorder, we’re here for you. We offer behavioral health treatment to our members who need some extra care. We’ll also connect you with local resources for more support.
Help in a crisis
Call 988 if you have a behavioral health emergency. This is the new number for the National Suicide Prevention Lifeline. Do you have thoughts of harming yourself or someone else? Their trained counselors can help you, 24 hours a day, 7 days a week. You can also chat online with a counselor through their Lifeline Chat service.
You can use any hospital for emergency care, even if it isn’t in our network. Just show your member ID card.
You can also call us at 1-833-491-1094. We’re here for you 24 hours a day, 7 days a week.
Maternity Matters is a program that helps you and your baby be as healthy as possible. Some benefits include:
- A new mom welcome kit and baby bundle with diapers, diaper bag and other items
- Info about healthy pregnancies and baby care
- Help from a care manager
- Local community programs and resources
- Info about family planning
- Coverage of long-acting birth control
- Coverage of circumcision for newborn boys
We’ll help you get birth control counseling and supplies. You can see any in-network or out-of-network provider. Any family planning care that you get is private. You can call us at 1-855-242-0802 (TTY: 711) to choose a family planning provider.
More about family planning
Members 18+ who smoke, vape, or use e-cigarettes may be eligible for a 6-month tobacco cessation program. It is designed to engage members early in their quit journey, even if they are not ready to quit.
It offers activities and one-on-one support from a certified tobacco cessation coach to help members who smoke discover and develop their own motivations and lead them to a successful quit.
Our program offers Pivot Breath Sensor, a pocket-sized device that measures carbon monoxide (CO) in exhaled breath. It works with a mobile app for real time feedback in support of behavioral change.
The app also offers activities, a certified tobacco cessation coach and an online support community. Members will also have access to free, clinically proven nicotine replacement therapies.
The Pivot program, without the Pivot Breath Sensor and nicotine replacement therapy (NRT) (due to U.S. Food and Drug Administration (FDA) regulations), serves individuals under 18 years with adult consent.
Questions on how to get started? You can call us at 1-855-242-0802 (TTY: 711).
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 help you learn more about your health, find a ride to your health care visits and more.
Some health issues need more care. Our care managers can help you manage chronic conditions like asthma, diabetes, chronic obstructive pulmonary disease (COPD) and more.
If it’s late at night or you can’t reach your 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.
You can reach the Nurse Line at 1-855-242-0802 (TTY: 711).
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.
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 for all members.
If you don’t have a ride to your appointment, we’ll help you get one. These rides are for the medical services we cover, like doctor visits, dental care and behavioral health care. Just call our transportation vendor at 1‑877‑917‑4150 (TTY: 1‑866‑288‑3133), Mon.-Fri., 7 AM to 7 PM. Be sure to call 48 hours before you need a ride. If you have an urgent need or need help with a ride you have already scheduled, you can call “Where’s my ride” at 1‑877‑917‑4151, 24/7.
Respite care for the homeless
The Salvation Army will provide short-term residential care with wraparound medical respite services for members 18 years old and over. These services include:
- Post-acute medical services
- Counseling
- Nutrition
- Housing stabilization
- Transitional care
Homeless members can live in a safe environment while they get the medical care they need. We’ll pay for up to 30 days of housing, respite and wraparound services. The Salvation Army has permanent supportive housing locations in Alexandria, Baton Rouge, Lafayette, Lake Charles, Monroe, New Orleans and Shreveport.
Safe Home Support
Tenant members 18+ can receive up to $1000 for remediation of identified housing risks, includes legal services for housing matters.
Home meal delivery
This benefit is for members who get supplementary security income (SSI) from the Social Security Administration. This includes members with limited income and resources who are:
- Disabled
- Blind
- Ages 65 or older
Children who are blind or disabled may also get SSI. Members can get two meals a day for up to 14 days after release from post-acute care.
Job skills training
Members ages 16 and older can take courses to ensure they have a good understanding of the workplace. You can develop skills in:
- Problem solving
- Communication
- Professionalism
These courses can help you move forward with your career goals. You can also take your high school equivalency test (HiSET) and get certification.
Need to learn more about these resources? You can call us 1-855-242-0802 (TTY: 711).
Special programs
These programs can help you live life as healthy as you can be. We have special programs and services to help you get the care you need. And prevent health issues in the future.
Other language and format needs
Need language help? Just call us at 1-855-242-0802 (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
Aetna is part of the CVS Health® family of companies.
All trademarks are the property of their respective owners.