Information on your existing health insurance coverage (if any), such as the type of plan and termination/end date
Your bank account number and routing number, so that you can enroll in the electronic funds transfer (EFT) option for premium payment
Aetna is the brand name for insurance products issued by the subsidiary insurance companies controlled by Aetna, Inc. The AAA Medicare Supplement Insurance Plans are insured by Aetna Health and Life Insurance Company (Aetna).
Not connected with or endorsed by the U.S. Government or the Federal Medicare Program.
This is a solicitation of Insurance. Contact may be made by an Insurance agent or Insurance Company. The Medicare Supplement Certificates are guaranteed renewable as long as the required premium is paid by the end of each grace period. The certificates have exclusions, limitations, terms under which the policy may be continued in force or discontinued. Certificates do not pay benefits for any service and supply of a type not covered by Medicare, including but not limited to dental care or treatment, eyeglasses and hearing aids. See Certificate documents for a complete description of benefits, exclusions, limitations and conditions of coverage. AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST. In some states, Medicare Supplement plans are available to under age 65 individuals that are eligible for Medicare due to disability or ESRD (early stage renal disease). Certificates not available in all States.
* Premium rates are subject to change and may vary based on the effective date of coverage, and the information provided by you.
Actual premium rate may change for individuals who have used tobacco products with the past  months and are applying outside of a Medicare Supplement Open Enrollment or Guaranteed Issue period.
**To be eligible for the Household Discount, you must enroll in an Aetna Medicare Supplement insurance policy at the same time as another Medicare eligible adult or the other Medicare eligible adult must currently be covered by an Aetna Medicare Supplement insurance policy. The Medicare eligible adult must be (a) your spouse; or (b) someone with whom you are in a civil union partnership, and (c) continuously resided with for the past  months.
Certificate forms issued in In ID, include AAAMSP14A ID, AAAMSP14B ID, AAAMSP14F ID, AAAMSP14G ID, and AAAMSP14N ID. In OK, include AAAMSP14A OK, AAAMSP14B OK, AAAMSP14F OK, AAAMSP14G OK, and AAAMSP14N OK. In OH, include AAAMSP14A OH, AAAMSP14B OH, AAAMSP14F OH, AAAMSP14G OH, and AAAMSP14N OH.