Members
iCare Medicare Plan - Northeast
Medicare Part D Prescription Drug Coverage
The iCare Medicare Plan-Northeast 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-Northeast. 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-Northeast coverage begins.
What is the Cost to Fill My Prescriptions?
Generic Prescription Drugs - $1 co-pay
After $2,700 annual limit
Generic Prescription Drugs - You pay 100%
Brand-Name Prescription Drugs - You pay 100%
After $4,350 out-of-pocket threshold
Generic Prescription Drugs - You pay the greater of a $2.40 co-pay or 5% coinsurance
Brand-Name Prescription Drugs - $6.00 co-pay or 5% coinsurance.
Extra Help (Low Income Subsidy)
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/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-Northeast covers thousands of prescription drugs. Click on the Comprehensive Formulary link on the right under PDF Resources 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 on the Pharmacy Listing link on the right under PDF Resources to see what pharmacies are in our network
Every year as long as you are a member of the iCare Medicare Plan-Northeast, 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
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:
- No premium for medically necessary services
- One dollar co-pay for generic prescription drugs (One dollar generic co-pay applies until you reach the $2,700 annual limit, then you pay 100% until your yearly out-of-pocket drug costs reach $4,350, then you pay the greater of a $2.40 co-pay or 5% coinsurance.)
- 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 206
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.
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
- 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
- Privacy Statement
- 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 BadgerCare Plus-Medicaid SSI
- Provider Directory/Pharmacy Directory/iCare Medicare Plan 2011
- 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.
