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iCare Medicare Plan SNP-DE (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for iCare Medicare Plan SNP-DE (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on iCare Medicare Plan SNP-DE (HMO D-SNP) in 2025, please refer to our full plan details page.
iCare Medicare Plan SNP-DE (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Eastern, South Central and Western Wisconsin. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that iCare Medicare Plan SNP-DE (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
iCare Medicare Plan SNP-DE (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about iCare Medicare Plan SNP-DE (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For iCare Medicare Plan SNP-DE (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The iCare Medicare Plan SNP-DE (HMO D-SNP) has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, your monthly premium for Part D is $43.50. After you meet your deductible, you will pay the costs for your drugs, but the specific costs for each drug tier are not listed. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The iCare Medicare Plan SNP-DE (HMO D-SNP) offers a range of benefits with varying costs. Inpatient hospital stays have a high copay, while outpatient services often involve coinsurance. Emergency and urgently needed services have a copay or no copay, respectively. Preventive, hearing, vision, and dental services are covered with no copays or low coinsurance, while home health and skilled nursing facilities have no copay and a low copay, respectively. The plan also offers transportation services, and some additional services like acupuncture and a meal benefit, with a copay of $0.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization and a doctor referral. For a Medicare-covered stay, the copay is $2185.00 for Inpatient Hospital-Acute and $2036.00 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse services have a minimum of 20% and a maximum of 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered, with 60 one-way trips per year and no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the iCare Medicare Plan SNP-DE (HMO D-SNP) with a $110 copay and no coinsurance. Urgently Needed Services are covered with no copay and 20% coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
The iCare Medicare Plan SNP-DE (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services with 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of up to 20% for routine hearing exams, and no copay. Fitting/Evaluation for Hearing Aids are covered with no copay. Prescription hearing aids are partially covered; Prescription Hearing Aids (all types) are covered with no copay, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The iCare Medicare Plan SNP-DE (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Contact lenses and eyeglasses (lenses and frames) are covered with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The iCare Medicare Plan SNP-DE (HMO D-SNP) plan covers dental services, with a 20% coinsurance for Medicare dental services. Other dental services, including oral exams, dental x-rays, and cleanings, have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the iCare Medicare Plan SNP-DE (HMO D-SNP). Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0-20%, while Other Medicare Part B Drugs have no copay and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the iCare Medicare Plan SNP-DE (HMO D-SNP) with 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a coinsurance of at most 20%, and Lab Services with a $30 copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $350 and a coinsurance of at most 20%, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the iCare Medicare Plan SNP-DE (HMO D-SNP) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the iCare Medicare Plan SNP-DE (HMO D-SNP). Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the iCare Medicare Plan SNP-DE (HMO D-SNP), but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture and a meal benefit, with prior authorization required for both. Acupuncture has no copay for up to 20 treatments per year, while the meal benefit also has no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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