If you are looking for Coventry Health Plan of Florida, the company no longer exists as a separate insurer. Aetna acquired Coventry Health Care in May 2013, and CVS Health acquired Aetna in November 2018.1U.S. Securities and Exchange Commission. Form 425 Filed by Aetna Inc.2CVS Health. CVS Health Completes Acquisition of Aetna Any Florida plan that was once branded Coventry is now underwritten and administered by Aetna. Your ID card may still carry the old name, but the plan documents, provider network, member services line, and appeals process are all Aetna’s.
Where to Go for Your Plan Now
Stop searching for Coventry-branded resources. They do not lead anywhere current. Use the Aetna website for Medicare plans and the Aetna Better Health of Florida website for Medicaid plans.3Aetna Better Health. Florida Medicaid Plans Your member ID number stays the same, and the customer service number printed on your card still routes to the right place even if the logo says Coventry. If you cannot find your card, call Aetna directly and give them your name and date of birth; they can look up the plan on their end.
For plan details that change year to year — formularies, provider directories, premiums, copays — always pull the current Evidence of Coverage from Aetna rather than relying on older paperwork filed under the Coventry name.
What Kind of Plan You Have
The Florida business that came out of Coventry is concentrated in two areas: Medicare for people 65 and older or with qualifying disabilities, and Medicaid for lower-income residents.
Medicare Advantage and D-SNPs
Most of these are HMO-style Medicare Advantage plans. You pick a primary care doctor from the network and get referrals to see specialists. The plan bundles your Part A hospital coverage, Part B outpatient coverage, and usually Part D prescription drug coverage into one card.
If you qualify for both Medicare and Medicaid, you may be in a Dual Eligible Special Needs Plan, or D-SNP. These coordinate the two programs so you get the Medicare benefits plus Medicaid extras like transportation, dental, and long-term services under a single plan. For people who are dually eligible, this usually means lower out-of-pocket costs than a standard Medicare Advantage plan.
Supplemental benefits vary. Original Medicare does not pay for routine dental, vision, or hearing care, and most Florida Medicare Advantage plans fill those gaps to some extent: cleanings and exams, an annual eye exam with an eyewear allowance, hearing exams, and some coverage toward hearing aids. The specifics and dollar limits differ by plan, so check your Evidence of Coverage before assuming a benefit is included.
Aetna Better Health of Florida (Medicaid)
Medicaid members are enrolled through Aetna Better Health of Florida, which participates in the state’s Managed Medical Assistance program. Eligibility covers low-income adults, children, pregnant women, and people with disabilities. There is also a separate Long-Term Care plan for members who need a nursing-facility level of care or extensive help at home.
Prescription Drug Costs in 2026
If your Medicare Advantage plan includes Part D, federal law now caps your out-of-pocket spending on covered drugs at $2,100 for the 2026 calendar year.4Medicare.gov. How Much Does Medicare Drug Coverage Cost? Once you reach that cap, you pay nothing for covered drugs the rest of the year. The old coverage gap, which left patients with expensive medications owing thousands, no longer applies the way it did.
If paying for an expensive prescription up front is the real problem, ask Aetna about the Medicare Prescription Payment Plan. It lets you spread your drug costs into monthly installments through the plan rather than paying the pharmacy the full amount at pickup. There is no fee or interest, and you can opt in or out by calling your plan.5Medicare.gov. What’s the Medicare Prescription Payment Plan? It does not change what you owe overall, only when you pay it.
Checking Providers and Emergency Care
With an HMO Medicare Advantage plan, your coverage depends on staying inside the network. Before you schedule anything, confirm the doctor or hospital is currently in-network for your specific plan using Aetna’s provider search. Medicare and Medicaid plans have separate directories, so make sure you are in the right one. Networks shift during the year; verify even if you have seen the same provider before.
Non-emergency care from an out-of-network provider, without a referral or prior authorization, can leave you responsible for the whole bill. Emergency care is different. Federal rules require Medicare Advantage plans to cover emergency services at any hospital, in-network or not, without higher cost-sharing for an out-of-network emergency room. If your plan denies an emergency claim because the hospital was out of network, appeal it.
Enrollment Windows
Medicare
To be in a Medicare Advantage plan, you need both Part A and Part B and you have to live in the plan’s Florida service area.6Centers for Medicare & Medicaid Services. Medicare Advantage Fact Sheet The main window to join, switch, or drop a plan is the Annual Enrollment Period, October 15 through December 7. Changes take effect January 1.7Medicare.gov. Open Enrollment
If you are already in a Medicare Advantage plan and want a change after December 7, the Medicare Advantage Open Enrollment Period runs January 1 through March 31. During that window you can switch to a different Medicare Advantage plan, or go back to Original Medicare and pick up a standalone Part D plan. Changes take effect the first of the month after the plan receives your request.8Medicare.gov. Joining a Plan You also get an Initial Enrollment Period when you first become eligible for Medicare and a Special Enrollment Period for qualifying events like moving out of your plan’s service area.
Medicaid
Medicaid eligibility runs on income, household size, and category, and enrollment is open all year for people who qualify. You apply through MyACCESS, the state portal run by the Florida Department of Children and Families, by phone, or on paper.9Florida Department of Children and Families. Applying for Assistance You will need proof of residency, income, and household composition.
If Your Plan Denies Coverage
Many services on a Medicare Advantage plan need prior authorization: specialist visits, non-emergency hospital stays, imaging, certain outpatient procedures. If your plan has not approved the service in advance when the rules require it, the plan can refuse to pay. Call member services or check your Evidence of Coverage before scheduling anything beyond routine care.
A denial of prior authorization is a coverage decision you can appeal. Know the difference between a grievance and an appeal first: a grievance is a complaint about how the plan operates (wait times, service quality), and it will not reverse a denied claim. If the plan refused to cover or pay for something, you need the appeals process.
Filing a Level 1 Appeal
You have 60 calendar days from the date you receive the denial notice to ask your plan to reconsider.10eCFR. 42 CFR Part 422, Subpart M – Grievances, Organization Determinations and Appeals CMS treats the notice as received five days after mailing, so in practice you have about 65 days from the date printed on the letter. The plan must decide within 30 days for a service request or 60 days for a payment request.11U.S. Department of Health and Human Services. Level 1 Appeals – Medicare Advantage Part C
If waiting that long could seriously harm your health, you or your doctor can request an expedited appeal, and the plan then has 72 hours to decide.12eCFR. 42 CFR 422.590 – Expedited Reconsideration The plan has to grant the faster timeline when your physician says a standard wait could jeopardize your health or recovery. Expedited appeals apply to services you have not yet received, not to bills you already paid.
If the Plan Says No Again
If your plan upholds its denial, it must forward the case automatically to an Independent Review Entity (currently MAXIMUS Federal Services). The IRE has 30 days for standard requests and 72 hours for expedited ones.13Centers for Medicare & Medicaid Services. Reconsideration by Part C Independent Review Entity Three further levels exist beyond the IRE — an Administrative Law Judge hearing, review by the Medicare Appeals Council, and federal court — each with its own dollar threshold.14Medicare. Appeals in Medicare Health Plans
Making the Appeal Count
Get a letter from your doctor that names your diagnosis, your treatment history, and why alternatives are inadequate. Generic letters rarely move the needle. Keep copies of everything you submit and note the date you sent it. If you call member services, write down the representative’s name and what they told you. If you want a family member or advocate to handle the appeal, use CMS Form 1696 (Appointment of Representative), signed by both of you; it stays valid for a year and lets the representative file paperwork, see your records, and receive plan communications.15Centers for Medicare & Medicaid Services. Appointment of Representative Form CMS-1696
One Note for Medicaid Members: Estate Recovery
If you are enrolled through Aetna Better Health or any other Florida Medicaid plan, the state has the right to recover from your estate the value of Medicaid benefits paid after you turned 55. Benefits received before 55 do not create this debt.16Online Sunshine. Florida Statutes 409.9101 – Recovery for Payments Made on Behalf of Medicaid-Eligible Persons The state cannot enforce the claim if you leave a surviving spouse, a child under 21, or a child who is blind or permanently disabled, and heirs or the personal representative can request a hardship waiver. Property exempt from creditor claims under Florida law is also protected. None of this affects your benefits while you are alive, but it matters if you own a home that would pass through probate.