Members

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. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. 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 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 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, 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.

Customer Service - Our Customer Service department is your link to everything you want to know about iCare. You can contact our Customer Service 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 premium, no deductible, no co-pay for medically necessary services
• Zero dollar co-pay for generic prescription drugs (up to $2,700 annual limit, then it will increase to $1.10 or $2.40 depending upon your level of income, then after reaching the $4,350 out-of-pocket threshold, you pay zero dollars)
• Free transportation to and from your medical/dental appointments (limits apply)
• Extra Value Benefits

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, 2010. 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.

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 iCare 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.

Involuntarily Disenrollment

If any of the following situations occur, we will end your membership in our Plan:

• If you do not stay continuously enrolled in Medicare A and B.
• If you are no longer considered eligible for Medicare.
• If you move out of the service area or are away from the service area for more than 6 months you cannot remain a member of our Plan. And we must end your membership (“disenroll” you)”. If you plan to move or take a long trip, please call Customer Service to find out if the place you are moving to or traveling to is in our Plan’s service area.
• If you knowingly falsify or withhold information about other parties that provide reimbursement for your prescription drug coverage.
• If you intentionally give us incorrect information on your enrollment request that would affect your eligibility to enroll in our Plan.
• If you behave in a way that is disruptive, to the extent that you continued enrollment seriously impairs our ability to arrange or provide medical care for you or for others who are members of our Plan. We cannot make you leave our Plan for this reason unless we get permission first from Medicare.

If you let someone else use your plan membership card to get medical care. If you are disenrolled for this reason, CMS may refer your case to the Inspector General for additional investigation.

Contact Us

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

Medicare

• iCare Medicare Benefits and Services
• Part D Prescription Drug Coverage
• Prescription Drug Information and Formulary
• Grievance Policy
• Exception and Appeals Policy
• Coverage Limitations