Members
2012 iCare Medicare Plan
Benefits and Services
- Evidence of Coverage
- Provider/Pharmacy Directory
- Comprehensive Formulary
- Summary of Benefits
- LIS Premium Summary Sheet
- Coverage Determination Request Form
- Redetermination Request Form
- CMS Appointment of Representative form
The iCare Medicare Plan is a Medicare Advantage program that offers health care benefits for all eligible Medicare beneficiaries with special needs. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Independent Care Health Plan (iCare) is a Coordinated Care plan with a Medicare Advantage contract and a contract with the Wisconsin Medicaid program. 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. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help that you receive, please contact the plan for further 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 offers you a wide choice of providers to choose from. The iCare Medicare Plan 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 use plan providers except in emergency or urgent care situations. If you obtain routine care from out-of-network 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, 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 $2.60 co-pay for generic prescription drugs (depending on your income level)
- For brand drugs, you will pay a co-pay of $0, $3.30 or $6.50 (depending on your income level.) After your yearly out-of-pocket drug costs reach $4,700, you pay a $0 co-pay.
- Free transportation to and from your medical/dental appointments (limits apply)
- Access to $15 of OTC (Over-the-Counter) medications delivered to your home, free of charge, each month
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, 2013. 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. 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.
Contact Us
For full information on iCare Medicare Plan 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.
Last Updated: 12/09/2011
Medicare
PDF Resources
Listing of CMS approved iCare Medicare publications, Medicaid publications, third-party preventive health brochures.
- Abridged Formulary/iCare Medicare Plan 2012
- Abridged Formulary/iCare Partnership 2012
- Annual Notice of Change (ANOC)/iCare Medicare Plan 2012
- Annual Notice of Change (ANOC)/iCare Partnership 2012
- Anti-Smoking Quit Line (English)
- Anti-Smoking Quit Line (Spanish)
- Caregiver Background Check Policy
- Claim Form LTC Professional Services - Trizetto
- Claim Form LTC Residential Services - Trizetto
- CMS Appointment of Representative Form
- Comprehensive Formulary/iCare Medicare Plan 2012
- Comprehensive Formulary/iCare Partnership 2012
- Direct Mail Postcard/2012 Additional Benefits/iCare Medicare Plan
- Direct Mail Postcard/2012 OTC/iCare Medicare Plan
- Direct Mail Postcard/2012 Walgreens/iCare Medicare Plan
- Emergency Room Brochure
- Enrollment Form/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Partnership 2012
- FCP Provider Reference Manual
- First Tier, Downstream and Related Entities Fraud
- Formulary Change Notice (iCare Medicare Plan)
- Formulary Change Notice (iCare Partnership)
- Limited English Proficiency Policy/Procedures
- LIS Premium Summary Sheet 2012
- Member Handbook/BadgerCare Plus Core Plan
- Member Handbook/iCare Medicaid SSI
- Member Newsletter Summer/Fall 2011/iCare BadgerCare Plus
- Member Recertification Reminder/BadgerCare Plus Core
- Notice of Privacy Practices
- Part D Coverage Determination Request Form
- Part D Prior Authorization Criteria/iCare Medicare Plan 2012
- Part D Prior Authorization Criteria/iCare Partnership 2012
- Part D Redetermination Request Form
- Pharmacy Listing/iCare Medicare Plan 2012
- Pharmacy Listing/iCare Partnership 2012
- Power of Attorney brochure
- Program Brochure/Hmong/iCare Medicaid SSI
- Program Brochure/iCare BadgerCare Plus
- Program Brochure/iCare Medicaid SSI
- Program Brochure/iCare Partnership
- Program Brochure/Spanish/iCare Medicaid SSI
- Program Overview (Spanish)/iCare Medicaid SSI
- Program Overview (Spanish)/iCare Partnership
- Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Expansion Counties
- Provider Directory/iCare Medicaid SSI-BadgerCare Plus_Original Counties
- Provider Directory/Pharmacy Directory/iCare Medicare Plan Expansion Counties 2012
- Provider Directory/Pharmacy Directory/iCare Medicare Plan Original Counties 2012
- Provider Reference Manual 2012
- Provider/Pharmacy Directory - iCare Partnership 2011
- Recertification Reminder (flyer)/BadgerCare Plus
- Report to the Community
- Self-Directed Supports Program Overview/iCare Partnership
- Step Therapy Prescription Drug Criteria/iCare Medicare Plan 2012
- Step Therapy Prescription Drug Criteria/iCare Partnership 2012
- Summary of Benefits/iCare Medicare Plan 2012
- Summary of Benefits/iCare Partnership 2012
- Transition Process
- Value to the Family
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.
