Members
2012 iCare Medicare Plan
How Do I Enroll?
- 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
How Do I Enroll?
It is easy. If you are interested in joining the iCare Medicare Plan, you can enroll at any time during the year. Simply complete our enrollment form and after your eligibility has been determined, we will send you a membership packet explaining how to access your iCare Medicare Plan benefits and services.
Enroll over the phone by calling us at 1-888-241-9664 (TTY 1-800-947-3529), 7 days a week, 8:00 am to 8:00 pm. Our Member Services department will put you in touch with one of our licensed insurance agents who will help you to enroll in our plan.
Medicare beneficiaries may enroll in the iCare Medicare Plan through the Centers for Medicare and Medicaid Services Online Enrollment Center located at www.medicare.gov. For more information about the iCare Medicare Plan, contact iCare’s Member Services department from 8:00 am to 8:00 pm, 7 days a week at 1-800-777-4376 (TTY: 1-800-947-3529.)
For more information contact our Member Services department at 1-800-777-4376 (TTY 1-800-947-3529), 7 days a week, 8:00 am to 8:00 pm.
You must enroll in both the iCare Medicare Plan as well as a full Medicaid HMO plan (including iCare’s or another plan) to receive full benefit coverage. You can also remain in Medicaid Fee-For-Service, but you will be subject to small co-pays if you do so. To find out about a full Medicaid HMO Plan that is best for your health care needs you may contact the Medicaid Managed Care Enrollment Specialist at 1-800-291-2002 (TTY: 1-800-325-0778).
Disenrolling
If you choose to leave the iCare Medicare Plan, 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 Care Medicare Plan 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 a.m. to 8:00 p.m. TTY users should call (800) 947-3529. We are open Monday through Friday, 8:00 a.m. to 8:00 p.m. Thank you.
iCare Medicare Plan 2012 Disclaimers - Independent Care Health Plan (iCare) is a Coordinated Care plan with a Medicare Advantage contract and a contract with the Wisconsin Medicaid program. To be eligible for the iCare Medicare Plan, you must live in our service area of Brown, Kenosha, Manitowoc, Milwaukee, Outagamie, Ozaukee, Racine, Sheboygan, Walworth, Washington, Waukesha, Waupaca and Winnebago counties. In addition, you must be eligible for Medicare and Medicaid benefits or eligible for Medicare cost-sharing assistance under Medicaid. Individuals must have both Part A and Part B to enroll. (Your Medicare Part B premium is paid by the State.) You cannot have End-Stage Renal Disease (exceptions may apply). You must also enroll in a full Medicaid HMO plan (including iCare’s or another plan) to receive full benefit coverage. You must receive all routine care from plan providers. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1, 2013. Please contact iCare for details. You may be able to get extra help to pay for your prescription drug premiums and costs. 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/7 days a week; the Social Security Administration at 1-800-772-1213 between 7:00 am and 7:00 pm, Monday through Friday, TTY/TDD users should call 1-800-325-0778; or your State Medicaid Office. The benefit information provided herein is a brief summary, not a comprehensive description of benefits. This plan is available to anyone who has both Medical Assistance from the State and Medicare. For more information, contact the plan. 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 full information on iCare benefits, call our Member Services Department at 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 am to 8:00 pm, 7 days a week.
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.
Notification:
By clicking the links above, you may be leaving the icare-wi.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the iCare.wi.org website. These external links are not the responsibility of, or under the control of iCare. Independent Care Health Plan disclaims responsibility for the content and privacy policies of the owners/sponsors of the outside websites.
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
- Emergency Room Brochure
- Enrollment Form/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Medicare Plan 2012
- Evidence of Coverage/iCare Partnership 2012
- Family Care Partnership Provider Application
- FCP Provider Reference Manual
- First Tier, Downstream and Related Entities Fraud
- Formulary Change Notice (iCare Medicare Plan)
- Formulary Change Notice (iCare Partnership)
- HCFA Claim Required Fields
- Limited English Proficiency Policy/Procedures
- LIS Premium Summary Sheet 2012
- Member Handbook/BadgerCare Plus Core Plan
- Member Handbook/iCare Medicaid SSI
- 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
- Plan Comparisons/iCare Partnership 2012
- Power of Attorney brochure
- Primary & Acute Care Information Form
- Prior Authorization List 4/19/12
- Prior Authorization List 4/19/12 pdf
- 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 Information Form (other than Partnership Program)
- Provider Reference Manual 2012
- Provider/Pharmacy Directory - iCare Partnership 2012
- Recertification Reminder (flyer)/BadgerCare Plus
- 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
- UB Claim Required Fields
- 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.
