Medicare Part D Prescription Drug
Coverage
The iCare
Medicare Plan’s all-in-one benefits include the Medicare Part D
Prescription Drug program, meaning you do not need to look for a separate
program to fulfill your prescription drug needs. Our Medicare Part D
Prescription Drug benefit is only available to members of the iCare
Medicare Plan. If you are already enrolled in a Medicare Advantage
Prescription Drug Plan, you must receive your Medicare Prescription Drug
benefit through that plan until your iCare
Medicare Plan coverage begins.
What is the Cost to Fill My Prescriptions?
Generic Prescription Drugs - $0 co-pay
Brand-Name Prescription Drugs - $3.10 or $5.60 co-pay (depending on your income level)
After
$2,510 annual limit
Generic Prescription Drugs - $1.05 or $2.25
(depending on your income level)
Brand-Name Prescription Drugs - $3.10 or $5.60
(depending on your income level)
After $4,050 out-of-pocket threshold
Generic Prescription Drugs - $0
Brand-Name Prescription Drugs - $0
Extra Help (Low Income Subsidy)
You may be able to get extra help to pay for your
prescription drug premiums and costs. You will have a $0 premium,
which does not include any Part B premium you may have to pay. Your
premium includes both medical services and prescription drug benefits.
To see if you qualify for getting extra help, call:
1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048,
24 hours-a-day/7days-a-week); the Social Security Administration at
1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD
users should call, 1-800-325-0778; or your State Medicaid Office.
Are My Medications Covered?
The iCare
Medicare Plan covers thousands of prescription drugs. Click here
to find out what drugs are covered in our formulary, or call Member Services
at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00
p.m.
Where Can I Get My Prescriptions Filled?
Members must use network pharmacies to obtain their
prescription drugs, except under non-routine cases when you cannot make it
to a network pharmacy. A network pharmacy is a pharmacy that has contracted
with the
iCare
Medicare Plan, where beneficiaries
access prescription drug benefits provided by the
iCare
Medicare Plan. In most cases, your prescriptions are covered under the
iCare
Medicare Plan only if they are filled at a network pharmacy. We have
contracted with over 1,000 retail pharmacies throughout the State of
Wisconsin, which equals or exceeds the Centers for Medicare and Medicaid
(CMS) requirements for pharmacy access in your area.
Click here to see what pharmacies are in our
network.
Every year as long as you are a member of the
iCare
Medicare Plan, we will send you a Provider Directory, which provides you
with a listing of network pharmacies. You can use it to find a network
pharmacy near you.
Filling Prescriptions Outside the Network
We have network pharmacies outside of the service
area where you can get your drugs covered as a member of our plan.
Generally, we only cover drugs filled at an out-of-network pharmacy in
limited circumstances when a network pharmacy is not available. Below are
some circumstances when we would cover prescriptions filled at an
out-of-network pharmacy. Before you fill your prescription in these
situations, call Member Services to see if there is a network pharmacy in
your area where you can fill your prescription. If you do go to an
out-of-network pharmacy for the reasons listed below, you may have to pay
the full cost (rather than paying just your co-payment) when you fill your
prescription. You can ask us to reimburse you for our share of the cost by
submitting a claim form. You should submit a claim to us if you fill a
prescription at an out-of-network pharmacy so that any amount you pay will help
you qualify for catastrophic coverage.
We will cover your prescription at an out-of-network
pharmacy if at least one of the following applies:
- If you are traveling within the United States
and territories and become ill, lose or run out of your prescription
drugs we will cover prescriptions that are filled at an out-of-network
pharmacy.
- If the prescriptions are related to care for a
medical emergency or urgent care.
- If you are unable to obtain a covered drug in a
timely manner within our service area because there is no network
pharmacy within a reasonable driving distance that provides 24 hour
service.
- If you are trying to fill a prescription drug
that is not regularly stocked at an accessible network retail or
mail-order pharmacy (including high cost and unique drugs).
- If you are getting a vaccine that is medically
necessary but not covered by Medicare Part B and some covered drugs that
are administered in your doctor's office.
We cannot pay for any prescriptions that are filled
by pharmacies outside of the United States and territories, even for a
medical emergency.
How Do I Submit a Paper Claim?
When you go to a network pharmacy, your claim is
automatically submitted to us by the pharmacy. However, if you go to an
out-of-network pharmacy for one of the reasons listed above, the pharmacy
may not be able to submit the claim directly to us. When that happens, you
will have to pay the full cost of your prescription. When you return home,
simply submit your claim and your receipt to the following address:
Independent Care Health Plan
1555 N. RiverCenter Dr., Suite 202A
Milwaukee, WI 53212
Upon receipt, we will make an initial
coverage determination on the
claim.
Plan Transition Process
Click here to see our plan transition process if you need some help in
finding out what to do if your temporary supply of non-formulary
prescription drugs is about to run out or to find out what options you have
if your present prescription drug is taken off of the
iCare
formulary.
Contact Us
Questions? Call us at 1-800-777-4376 (TTY
1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.
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