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2023 iCare Medicare Plan

Are you getting all the benefits you're entitled to from Medicare and State Medicaid?  ARE YOU SURE?

 

Added Benefits    How to Enroll   Part D Prescriptions  Find a Provider
 
 
2023 Benefits Update
 

iCare Medicare Plan

Main Content
 
 

2023 Added Benefits

As a member of iCare Medicare Plan (HMO D-SNP), you receive extra added benefits above what Original Medicare covers, for $0 premium and $0 deductible.

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Healthy Options Allowance - NEW!

iCare Medicare Plan members have the freedom to spend a $150/month allowance on the approved products and services you need with the iCare Spending Account Card!

In 2023, members have the freedom of ONE wallet on ONE card with the $150/month Healthy Options allowance. Watch for your Spending Account Card and OTC catalog in your mailbox. Be sure to read the information on the card carrier, including the instructions on how to activate your new card, so you'll be ready when it's time to purchase eligible items and services.

Learn more about the Healthy Options Allowance!

 

Added Dental Benefits - ENHANCED for 2023!

 

iCare includes preventive and comprehensive dental benefits in your plan with no monthly dental premium and a $4,000 maximum coverage limit per calendar year. You must use dentists and dental specialists in the iCare dental network, DentaQuest. To find a dentist call
DentaQuest's Customer Service at 1-800-508-6758 (TTY: 711). You can also call iCare Customer Service at 1-800-777-4376 or your Care Coordinator. If you have access to the internet, you can find a dentist by using the "Find a Provider" tool on the iCare web site at www.iCareHealthPlan.org. These added benefits are included in the plan at no cost to you:


$0 Co-pay for Preventive Care
» Oral Exams — Up to three (3) per calendar year, includes emergency diagnostic exam up to one (1) per year, and
periodic oral exam up to two (2) per year.
» Prophylaxis (Cleaning): Up to six (6) per calendar year, includes periodontal maintenance up to four (4) per year and
prophylaxis (cleaning) up to two (2) per year.
» Fluoride Treatment: Up to two (2) per calendar year.
» Dental X-rays include bitewing x-rays and intraoral x-rays up to one (1) set(s) per year, and panoramic film or
diagnostic x-rays up to one (1) every 5 years.


$0 Co-pay for Comprehensive Care
» Non-routine Services: Two (2) visits included every year.
» Diagnostic Services: One (1) visit included every 3 years.
» Restorative Services: Include fillings up to unlimited per year ,re-cementation of crown and re-cementation of dentures up to one (1) every 5 years, crown up to one (1) per tooth per lifetime.
» Endodontics: Include root canal, root canal retreatment up to one (1) per tooth per lifetime.
» Periodontics: Include scaling and root planning (deep cleaning) up to one (1) per quadrant every 3 years, scaling for moderate inflammation up to one (1) every 3 years.
» Extractions: Surgical extractions are covered; Unlimited per year.
» Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services: Include partial dentures and complete dentures up to one (1) set(s) every 5 years, denture adjustment, denture reline, denture repair, denture rebase, tissue conditioning up to one (1) per year, occlusal adjustments up to one (1) every 3 years, oral surgery up to two (2) per year, and bridges up to one (1) every 5 years.

There may be limits on how much the plan will provide. Please contact us for more information.

Vision Benefits - ENHANCED for 2023!

 

There's no monthly vision premium and you can choose from an extensive network of National Vision Administrators (NVA) care providers.

Our added vision benefit provides you with these services in 2023:
» $50 combined maximum benefit coverage amount per year for routine exam.
» $400 combined maximum benefit coverage per year for contact lenses or eyeglasses (lenses and frames) and/or fitting for eyeglasses (lenses and frames).

Eyeglass lens options may be available with the maximum benefit coverage amount up to one (1) pair per year.

Maximum benefit coverage amount is limited to one time use per year.

Please refer to your iCare Medicare Plan Evidence of Coverage or EOC for more information or call your Care
Coordinator. You can also call iCare Customer Service at 1-800-777-4376 (TTY: 711).

There may be limits on how much the plan will provide. Please contact us for more information.

You must use National Vision Administrators (NVA) network providers for your Medicare vision benefit. If you have a vision network question or need help finding a provider, call the NVA Customer Service Department 24/7/365 at 1-888-287-0116 (TTY: 711). You can also visit www.e-nva.com or use the “Find a Provider” search tool on the iCare web site www.iCareHealthPlan.org.

SilverSneakers® Fitness

 


SilverSneakers is more than a fitness program, it's a way of life. It gives you the opportunity to connect with your community, make friends, and stay active. The best part? SilverSneakers is included in this plan at no additional cost. 

What does SilverSneakers include? 

»    Fitness Memberships: Thousands of popular location1 – visit as many as you wish!
»    Classes: Classes2 for all levels and abilities led by instructors who specialize in senior fitness.
»    Online Resources: Fitness location directory, health and nutrition tips, and SilverSneakers On-Demand™ video workouts at SilverSneakers.com.
»    Mobile App: SilverSneakers GO™ mobile app with workout programs, location finder and more.

At-home kits are offered for members who prefer working out at home or for those who can’t get to a fitness location due to injury, illness, or are homebound. Call to get yours.  The type of kit is subject to availability.

PLEASE NOTE: SilverSneakers no longer mails ID cards. To participate in SilverSneakers you only need your SilverSneakers ID number. Getting it is easy:
» Go to SilverSneakers.com/eligibility and follow the steps.
» Download the SilverSneakers GO™ app -> log in -> tap the profile icon. Your ID will appear at the top of the next screen.
» Call SilverSneakers at 1-888-423-4632 or 1-866-584-7389, Monday through Friday, 8:00 a.m. to 8:00 p.m., ET. SilverSneakers membership is usually effective by the middle of the month after you enroll in iCare Medicare Plan. If you have any issues, please call iCare Customer Service.

SilverSneakers is a registered trademark of Tivity Health, Inc. © 2022 Tivity Health, Inc. All rights reserved. 1. Participating locations (PL) are not owned or operated by Tivity Health, Inc., or its affiliates. Use of PL facilities and amenities are limited to terms and conditions of PL basic membership. Facilities and amenities vary by PL. 2. Membership includes SilverSneakers instructor-led group fitness classes. Some locations offer members additional classes. Classes and amenities vary by location. Tivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries. SilverSneakers On-Demand and SilverSneakers GO are trademarks of Tivity Health, Inc. ©2022 Tivity Health, Inc. All rights reserved.

Mom's Meals - ENHANCED for 2023!

If you are transitioning to home from a stay at an inpatient hospital or skilled nursing facility, you may be eligible for two (2) meals per day for 7 days, up to 14 meals delivered to your home. Meal delivery must be scheduled within 30 days of discharge. Limited to four (4) times per year. Please call your Care Coordinator to see if you are eligible for this benefit. Prior Authorization and/or doctor's referral (order) may be required for this benefit.

Non-Emergency Transportation (NEMT) - ENHANCED for 2023!

iCare Medicare Plan members receive 50 one-way trips, up to 25 miles each way, at a $0 co-pay. To arrange transportation, please call ModivCare at 1-877-813-5602 (TTY: 711). There may be limits on how much the plan will provide. Please contact the plan and/or your Care Coordinator for more information as there may be limits on how much the plan will provide.

Personal Emergency Response System (PERS)

The personal emergency response system provides help in emergency situations. The medical alert service comes with an installed in-home communication device and a wearable button. Please call your Care Coordinator to see if you are eligible for this benefit. Prior Authorization or doctor's referral (order) may be required to receive this benefit.

Part D Prescription Drug Benefits

NEW for 2023! $0 Rx Drug Co-Pays

Coverage may include $0 co-pay for all Medicare covered Part D prescription drugs on iCare Medicare Plan’s formulary, for all tiers, and through all drug stages for members who receive “Extra Help” for prescription drug costs.

Part D Prescription drugs on Tiers 1 through 4 are a $0 co-pay at a 1-month or 3-month supply. Tier 5 (Specialty Drugs) is a $0 co-pay and limited to a 30-day supply. To learn more about the plan’s Medicare Part D prescription drug coverage, the stages and drug tiers, please review the Summary of Benefits.


Verify Your Drugs are Covered
Look for your drug (medication) on the Drug List (Comprehensive Formulary) by visiting www.iCareHealthPlan.org or you can call Customer Service at 1-800-777-4376 (TTY: 711). If your drug isn't on the Formulary, it may not be covered, but there will likely be an alternative drug that treats the same condition. Some drugs have codes such as PA (Prior Authorization), Step Therapy (ST), and QL (Quantity Limit) by their names on the drug list. This means you or your doctor may need to give the plan more information or try an alternative medication before your drug will be covered. Please call Customer Service if your drug has one of these codes and we can help.


Find a Pharmacy Near You
There are many pharmacies in the plan's network located near you. You'll need to use a network pharmacy, or the plan may not pay for your prescriptions, except in an emergency. Find a pharmacy near you by visiting www.iCareHealthPlan.org or calling Customer Service at 1-800-777-437.

 

Get a 90-Day Supply of Your Prescriptions Delivered Right to Your Door
Save trips to the pharmacy for your maintenance prescriptions — the drugs you take every day — for conditions like high blood pressure and diabetes by getting a 90-day supply of medications. You can use our home delivery program through MedImpact OR your local in-network pharmacy. The choice is yours, but mail-order is very convenient!
 
 
Blood Glucose Meter and Test Strips
iCare Medicare members are eligible to receive diabetic testing supplies at no cost from Abbott Diabetes Care. This includes the FreeStyle® brand blood glucose meters and FreeStyle® brand test strips.
 
 
Prescription Portal and MedImpact Mobile App
The iCare Prescription Portal and the MedImpact mobile app will help you quickly manage your budget and health from your computer, tablet, or phone.
 
 
Medication Therapy Management
Members have the option of enrolling in Medication Therapy Management (MTM) services through myMTMcare. Members who meet the following criteria will be eligible for MTM services and a Comprehensive Medication Review.  To check to see if you are eligible, call Customer Service at 1-800-777-4376 (TTY: 711). Eligible members can opt out of the MTM program — participation is voluntary. Although the MTM program is a special service offered at no cost to our Medicare members, it is not considered a benefit.
 
Wellness and Health Care Planning

As an iCare member, you have access to an online advance care planning resource called Five Wishes. This resource helps you to create an advance directive where you can combine the elements of a living will, medical power of attorney, do not attempt resuscitation, and an organ donation form.

Flexible Care Assistance - ENHANCED for 2023!

We understand many factors can impact your health. This is why iCare offers the Flexible Care Assistance Benefit+. Members who are eligible and participate in Care Management are given an allowance up to $500/year to offset costs on items and services such as:


» Medical expense assistance
» Housekeeping services
» Meal delivery services
» Caregiver services
» Adult day care
» Utilities and/or rent
» Non-medical transportation
» Medical supplies and prosthetics
» Pest control
» Alternative therapies
» Home and bathroom safety devices

Members may discuss a full list of items and services with their Care Coordinator. This allowance may be used at your Care Coordinator's discretion and will be used to address your unique needs. Members must have one of the following conditions to use the Flexible Care Assistance Benefit:

» Chronic alcohol and other drug dependence
» Autoimmune disorders
» Cancer
» Cardiovascular disorders
» Chronic heart failure
» Dementia
» Diabetes
» End-stage liver disease
» End-stage renal disease
» Severe hematologic disorders
» HIV/AIDS
» Chronic lung disorders
» Chronic and disabling mental health conditions
» Neurologic disorders
» Stroke

Benefits are limited to a maximum amount of $500, all services combined, per year and must be coordinated and authorized by a Care Coordinator/Manager. Contact your care team to learn how this benefit can work for you.

+The benefit mentioned is a part of a special supplemental program for the chronically ill. Not all members qualify.

Get MORE in 2023 with your Healthy Options Allowance

iCare Medicare Plan (HMO D-SNP) members and iCare Family Care Partnership (HMO D-SNP) members have the freedom to spend a $150/month allowance on the approved
products and services you need with the iCare Spending Account Card!


Buy healthy foods, OTC products, living support such as rent, utilities and internet and much more!

Spending Account Card for OTC, Healthy Foods and more!
Learn More!

Extra programs & services come with your plan!

Your health needs go beyond the benefits you receive. In addition to the health insurance benefits, did you know about the extra programs and services we offer iCare Medicare Plan members? Social programs and services, health and wellness programs, and more — all working with your health care to keep you independent, healthy and happy.

 

Care Management

There are many people at iCare working together to meet your health care needs:

  • Care Coordinators are available to assist you with your care, should you need it.
  • Clinical Pharmacists, medical doctors, and registered nurses at iCare are trained in reviewing Prior Authorizations and doctor orders.
  • Specialty Services/Medical Disease Management teams are a resource available for you to ensure you receive the level of care you need if you have chronic health needs.
  • Specialty Services/Behavioral Health Disease Management teams including intervention specialists, registered nurses and care managers work together if a member has a condition like depression, anxiety disorder or suffer from alcohol or drug abuse, to name a few.

 

Community Health Workers

We offer a team of Community Health Workers (CHW) that can help you and your family with your social determinants of health (SDOH). What is SDOH? Many people assume that their health is only a result of their DNA or their family history. It's not just who you are that determines how healthy you are. Where you live, what you eat, how you learn and how you interact with others have an impact on your health, too. The CHW will also provide health education resources and information. They will provide support and guidance to you through face-to-face home or facility visits or by phone. There is no cost for you to work with a CHW.

 

Health and Wellness: 24/7 Nurse Line 

Staying healthy starts by asking questions and getting up-to-date information. When you need answers the Nurse Advice Line will be there for you 24 hours a day, 7 days a week. Call 1-800-679-9874.

 

Food Accessibility

Getting healthy foods can be a challenge for some people and iCare is here to help. In addition to the Healthy Options allowance benefit which allows you to purchase Healthy Foods, our Care Coordinators and Community Health Workers can share resources where you can get nutritious food affordably, safely and conveniently. They can also connect you directly to local organizations offering programs like home delivery, mobile neighborhood-based food trucks, and farmer’s markets accepting food assistance programs such as FoodShare Wisconsin. Interested in growing your own produce? iCare has a Community Gardening Program. Ask us how you can participate!
 

Eviction Control and Housing Relocation Program


If you are facing eviction, iCare may be able to help. Our staff of housing navigators may work with you and your property owner to try and keep you in your home and may connect you to new housing if you must move. We also have resources for our homeless members. For more information, please contact Customer Service.

Diversity and Accessibility

Our multilingual Care Coordinators speak fluently in languages such as Spanish and Hmong to help you understand your benefits and services. We also provide over the phone interpreter services for those members who do not speak English.  This service can be accessed by calling our Customer Service department or our Member Advocates/Member Rights Specialists. All non-English speaking members are directed to network physicians who understand their culture. Our provider network includes primary and specialty care providers who practice in areas where you live and spend time. In addition to a multilingual staff, there is a TTY phone number (711) for the hearing impaired. Special services are available for those who are blind or have limited vision.

How to ask for a Benefit or Service

Did you know you can ask for a benefit or service by sending iCare an Organization Determination request?  Or that you can appoint a representative?

 Learn how to ask for a benefit or service

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) 24 hours-a-day, 7 days-a-week (office hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.).
 

Find a Provider

Looking for a hospital, doctor or other provider in iCare's broad network?

 

Find a Provider

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