Medicare Counseling: Dual Eligible Special Need Plans (D-SNP) Plan – iCare Medicare Plan (HMO D-SNP) Partial Medicaid

Check what D-SNPs are available in your county and what Medicaid plans they accept. (Excel) After learning which plans you be able to get in your area, click on the plan names below to learn more about the plans.

iCare Medicare Plan (HMO D-SNP, H2237-001) for people with partial Medicaid

 For calendar year 2024

Contact information

 Phone: 800-777-4376
TTY: 711
 Website: https://www.icarehealthplan.org

 Eligibility

Who can get this plan

People with the Specified Low Income Medicare Beneficiary (SLMB) tier of the Medicare Savings Program

People with full Medicaid and/or the Qualified Medicare Beneficiary (QMB) tier of the Medicare Savings Program can also get this plan but will have different costs. View those costs on the iCare Medicare Plan for people with full Medicaid webpage.

 Service area

iCare Medicare Plan service area

Star rating

    
3.5 out of 5 stars

Coverage

 Check if your doctors are in-network: Provider search

 Check if your prescription drugs are covered: Comprehensive formulary

 Costs

 Doctor visit: You pay 20% coinsurance

 Hospitalization: You pay 20% coinsurance

Skilled nursing facility: You pay 20% coinsurance

Emergency department: You pay 20% coinsurance

Extra benefits

Details: Summary of benefits

 Basic dental:

• Two to three oral exams per year
• Up to six cleanings per year
• Two fluoride treatments
• Dental X-rays: Includes bitewing x-rays and intraoral x-rays up to one set(s) per year, and panoramic film or diagnostic x-rays up to one every five years

$4,000 coverage maximum for preventative and comprehensive care

 Extra dental: Prior authorization required. There is a $4,000 coverage maximum for preventative and comprehensive care.

 Vision:

• One routine eye exam, up to $50
• $400 per year towards contacts or glasses

 Hearing:

• $0 co-pay for routine hearing exams up to one every year
• $0 for follow-up provider visits (unlimited)
• $0 co-pay for each advanced level hearing aid up to one per ear every three years

Wellness programs: SilverSneakers

Other:

• $150/month towards groceries, over-the-counter products, home supplies from select retailers, non-medical transportation, utilities, rent, assistive devices, pest control, or pet care
• Non-emergency transportation: 50 one-way trips to approved locations (up to 25 miles per trip)
• Post-hospitalization meals: two meals a day for up to seven days; limit four times a year

 How to enroll

You can only enroll during a Medicare enrollment period; learn more at Medicare.gov.

Enrollment into this plan will automatically disenroll you from your current Medicare Advantage or Part D plan.

There are multiple ways to enroll:

• Contact the plan at 866-790-6503 or icarehealthplan.org
• Medicare.gov
• 1-800-MEDICARE
• Contact the State Health Insurance Assistance Program (SHIP)