Members

2010 iCare Medicare Plan (HMO)
Benefits and Services

The iCare Medicare Plan is a Medicare Advantage program that offers health care benefits for all eligible Medicare beneficiaries with special needs. Independent Care Health Plan (iCare) is a Health plan with a Medicare contract. We have combined health care services provided by Medicaid and Medicare to offer you a complete package of benefits, including the Medicare Part D Prescription Drug program.

Except for a small co-pay for brand-name drugs, most of these benefits are at no cost to you. Our care management benefits make us different, providing you with a personal level of care and the ability to reach us 24 hours-a-day. Co-pays, coinsurance and deductibles may vary based on income. Contact iCare for details. For a complete view of iCare Medicare Plan benefits, refer to the Evidence of Coverage.

Independent Care Health Plan (iCare) Medicare Plan Features

Provider Network - The iCare Medicare Plan (HMO) offers you a wide choice of providers to choose from. The iCare Medicare Plan (HMO) provides medical services through Medicare-certified doctors, health care professionals, hospitals and other health care facilities. You are not required to choose a primary care provider (PCP), but we strongly encourage your doing so. You must receive all routine care from plan providers. If you obtain routine care from non-plan providers, neither Medicare nor iCare Medicare Plan will be responsible for the costs.

Multi-Level Care Management - We look at your medical and social services needs. Care management recognizes there are medical as well as non-medical needs that have to be addressed in order to maximize your health.

  • Care Coordinators and Care Managers
    When you join the iCare Medicare Plan (HMO), you will be assigned a care coordinator or care manager. We will call you to perform an assessment, but feel free to call and schedule an appointment. This person works with you and your family to help you get the medical care and community services information you need. Your care coordinator can help you choose a health care support group, a specific community center, or group housing program in your area. We also offer information and referrals to programs designed to help you get the most out of your health care coverage, such as exercise or smoking cessation programs.
  • Nurse Case Managers
    Nurse case managers work with iCare staff when dealing with complex medical, behavioral or social needs. The care coordinator or care manager will continue to work with you while the nurse case manager is helping out.
  • Intervention and Outreach
    If you are struggling with mental health issues or substance abuse, we may provide support for behavioral change and assistance locating community resources. Our health outreach works with members with special needs and assists them in accessing preventive services.

Member Services - Our Member Services department is your link to everything you want to know about iCare. You can contact our Member Services department at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.

Benefits Include:

  • No Plan premium (Your Medicare Part B Premium is paid by the State) and no plan deductible
  • $0, $1.10 or $2.50 co-pay for generic prescription drugs (depending on your income level)
  • For all other prescription drugs, you will pay a co-pay of $0, $3.30 or $6.30 (depending on your income level.) After your yearly out-of-pocket drug costs reach $4,550, you pay a $0 co-pay.
  • Free transportation to and from your medical/dental appointments (limits apply)
  • Access to $16 of OTC (Over-the-Counter) medications delivered to your home, free of charge, each month

Independent Care contracts with the Federal government to offer this Medicare Advantage program. Independent Care's contract with the Centers for Medicare and Medicaid Services (CMS) is renewed on a yearly basis and benefit coverage beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy, network premium and/or copayments/co-insurance may change on January 1, 2011. Please contact iCare for details.

Notice for Potential Contract Termination

Independent Care Health Plan (iCare) is authorized by law to refuse to renew its contract with the Centers for Medicare and Medicaid Services (CMS). CMS may also refuse to renew its contract with iCare. If the contract between iCare and CMS is not renewed or terminated, this may result in the termination of your enrollment in the iCare Medicare Plan (HMO). In addition, iCare may reduce its service area and has the right to no longer offer services in the area where the beneficiary resides. If this occurs, you will receive another notice and instructions for continuity of care.

Disenrolling

If you choose to leave the iCare Medicare Plan (HMO), here are some items to remember:

  • Please remember, if you disenroll and do not enroll in another Medicare Advantage Plan with prescription drug coverage (or Medicare Prescription Drug Plan) or if you do not obtain other creditable coverage as good as Medicare, you may have to pay a penalty if you enroll in Medicare prescription drug coverage in the future.
  • Please be patient. It will take a few weeks for us to process your disenrollment and update Medicare's records. If your doctors need to send Medicare claims, you may want to tell them that you just disenrolled from the iCare Medicare Plan (HMO) and there may be a short delay in updating your records.
  • A NOTE ABOUT MEDIGAP RIGHTS: If you will be changing to the Original Medicare Plan you might have a special temporary right to buy a Medigap policy, also known as Medicare supplement insurance, even if you have health problems. For example, if you are age 65 or older and you enrolled in Medicare Part B within the past 6 months or if you move out of the service area, you may have this special right. Federal law requires the protections described above. Your State may have laws that provide more Medigap protections. For information, you can contact the Wisconsin Board on Aging and Long-Term Care at 1402 Pankratz Street, Suite 111, Madison, WI, 53704 or call the Medigap Helpline, a service of the Board on Aging and Long-Term Care at 1-800-242-1060 or the Medicare Counseling Service, provided by Southeastern Wisconsin Area Agency on Aging at 1-877-333-0202. You can also find the website for the Wisconsin Board on Aging and Long-Term Care at www.medicare.gov on the web. Under "Search Tools," select "Helpful Phone Numbers and Websites." The state of Wisconsin also has Ombuds who can help you with questions or problems. Call 1-800-760-0001 to speak to an Ombuds.
  • Call 1-800-MEDICARE (1-800-633-4227) for more information about trial periods. TTY users should call 1-877-486-2048. If you need any help, please call us at call (800) 777-4376, Monday through Friday, 8:00 am to 8:00 pm. TTY users should call (800) 947-3529. We are open Monday through Friday, 8:00 am to 8:00 pm. Thank you.

Contact Us

For full information on iCare Medicare Plan (HMO) benefits, call our Member Services Department at 1-800-777-4376 (TTY 1-800-947-3529), 7 days-a-week, 8:00 a.m. to 8:00 p.m.

 

  
 
More Forms & Publications

Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.

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