Benefits

Covered services

Medi-Cal provides a core set of health benefits, including doctor visits, hospital care, immunization, pregnancy-related services and nursing home care. A full list of covered services is found in your member handbook/EOC. All services must be medically necessary. Your doctor may have to ask us for prior approval before you can get some services.

Members will need to show both their Aetna Better Health ID card and their Medi-Cal Benefits Identification Card (BIC) for services listed as “Medicaid FFS.” If you have questions about coverage or getting services, call Member Services at 1-855-772-9076, TTY 711.

There are some services that you can only get from Medicaid Fee-for-Service. These services are listed as “Medicaid FFS”. Aetna Better Health of California does not pay for these services, but the Medi-Cal program (DHCS) does.

You must tell us when you need these services. You may get these services through any provider that will accept Medi-Cal patients. Aetna Better Health or your PCP can help you find a provider for these services. If you need these services, please call your PCP or Member Services for help.

We also cover services to help you manage chronic diseases, such as:

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Heart failure (HF)
  • Coronary artery disease (CAD)
  • Depression
  • Diabetes

Call us at 1-855-772-9076, TTY 711 for help in managing your disease. We can help you or your child learn to manage these chronic conditions and lead a healthier life.

As a member you are eligible to participate.
If you are diagnosed with any of these chronic conditions, or at risk for them, you may be enrolled in our disease management program. You can also ask your provider to request a referral. If you want to know more about our disease management programs, call us at 1-855-772-9076, TTY 711.

I do not want to participate.
You have the right to make decisions about your health care. If we contact you to join in one of our programs, you may refuse. If you are already in one of our programs, you may choose to stop at any time by contacting us at 1-855-772-9076, TTY 711.

Dental emergencies - If you need emergency dental care call your dentist.
Dental emergencies include:

  • A broken tooth
  • A permanent tooth falls out
  • Gum pain with fever

Children dental services - We cover dental services for children through the month of their 21st birthday, including:

  • Dental screening/oral health assessment by PCP
  • Fluoride varnish for members under 6 years of age by a PCP

Children vision
We cover vision services for children through the month of their 21st birthday, including:

  • 1 routine exam every 24 months for members under 21 or women through postpartum
  • 1 pair lenses/frames for members under 21 or women through postpartum

Adult vision
We cover these vision services for adults:

  • Eyeglasses for members under the age of 21 who qualify, as determined by Aetna Better Health
  • Eyeglasses for pregnant women through postpartum
  • Routine eye exam once in 24 months