2027 Medicare Advantage plan

iCare Family Care Partnership (HMO D-SNP): 2027 benefits and costs

iCare HMO D-SNP Special Needs Plan

CMS plan ID: H2237-007-0 · Plan year: 2027

iCare Family Care Partnership (HMO D-SNP) is a 2027 Medicare Advantage plan offered by iCare. It is listed in Wisconsin.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$0.00

In-network medical out-of-pocket maximum$9,250.00

Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.

Organization: iCare
Plan organization: INDEPENDENT CARE HEALTH PLAN
Parent company: Humana Inc.
Plan type: HMO D-SNP
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Dual-Eligible
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: Same as Medicare's Part B deductible
Applies to certain in-network Medicare-covered services.
In-network medical maximum: $9,250.00

Who can join this Special Needs Plan?

This plan is for people who qualify for both Medicare and Medicaid. The plan must confirm the required Medicaid eligibility level. Your costs can depend on your assistance level.

Plan eligibility type: Dual-Eligible

2027 benefit summary

Doctor visits and medical care

Plan-level deductibles may still apply when a service-specific deductible is listed as No.

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	20% coinsurance Service-specific deductible No
Specialist visit	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Emergency care	$115.00 copay
Urgent care	20% coinsurance
Home health	$0.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Dialysis	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	$0.00 copay; 0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Medicare-covered foot care	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Other health professionals	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$2,230.00 copay per stay	Approval required Yes Referral required Yes Benefit period Original Medicare
Inpatient mental health care	$2,080.00 copay per stay	Approval required Yes Referral required Yes Benefit period Original Medicare
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day	Approval required Yes Referral required Yes Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	20% coinsurance Service-specific deductible No
Hospital observation services	20% coinsurance Service-specific deductible No
Ambulatory surgical center	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Outpatient blood	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Laboratory services	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Diagnostic radiology (CT, MRI)	$205.00 to $345.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
X-rays	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Opioid treatment program	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Mental health, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Mental health, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Intensive cardiac rehabilitation	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Pulmonary rehabilitation	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$325.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	$0.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	$0.00 copay Service-specific deductible No	Approval required Yes
Diabetic monitors	$0.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	20% coinsurance
Oral examsAdditional plan benefit	$0.00 copay
Dental X-raysAdditional plan benefit	$0.00 copay
Dental cleaningAdditional plan benefit	$0.00 copay
FluorideAdditional plan benefit	$0.00 copay
Restorative dental careAdditional plan benefit	$0.00 copay
Root canal treatment (endodontics)Additional plan benefit	$0.00 copay
Gum treatment (periodontics)Additional plan benefit	$0.00 copay
Removable dentures (prosthodontics)Additional plan benefit	$0.00 copay
Fixed dental restorations (prosthodontics)Additional plan benefit	$0.00 copay
Oral surgeryAdditional plan benefit	$0.00 copay
Other dental servicesAdditional plan benefit	$0.00 copay

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Medicare-covered eyewear	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	20% coinsurance Service-specific deductible No	Approval required Yes Referral required Yes
Over-the-counter hearing aidsAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Supplemental acupunctureAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Over-the-counter health itemsAdditional plan benefit	$0.00 copay Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

OTC Max Allowance

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Over-the-counter health items; Over-the-counter hearing aids
How benefits are provided: Catalogue Purchase
Advance choice of benefits required: No
Shared benefit limit: $25.00
How often this limit applies: Every three months
Shared limit on visits or trips: No

Benefits for qualifying members

Virtual Cardiac Recovery Program

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Congestive Heart Failure (CHF); Hypertension; Other 1; Other 2
Qualifying conditions: Pneumonia
Qualifying conditions: Respiratory Illnesses
All listed conditions required: No
Combination of conditions required: No
Included services: Other 1
Some package benefits are exempt from the deductible: Yes
Services exempt from the deductible: Other 1

Prescription drug coverage

Costs shown are for initial coverage.

Standard retail costs

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$0.00	$0.00
Tier 2Generic	$0.00	$0.00
Tier 3Preferred Brand	24%	24%
Tier 4Non-Preferred Drug	25%	25%
Tier 5Specialty Tier	33%	Not listed

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$0.00	$0.00
Tier 2Generic	$0.00	$0.00
Tier 3Preferred Brand	24%	24%
Tier 4Non-Preferred Drug	25%	25%
Tier 5Specialty Tier	33%	Not listed

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$10.00	$30.00
Tier 2Generic	$20.00	$60.00
Tier 3Preferred Brand	24%	24%
Tier 4Non-Preferred Drug	25%	25%
Tier 5Specialty Tier	33%	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	24%
Tier 4Non-Preferred Drug	25%
Tier 5Specialty Tier	33%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	24%
Tier 4Non-Preferred Drug	25%
Tier 5Specialty Tier	33%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 33 county listings across 1 state or territory