Added Dental Benefits
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): 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.
Added Vision Benefits
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 2024:
» $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 website www.iCareHealthPlan.org.
Meals
Members receive two meals per day for 7 days (up to 14 meals) delivered to member’s home after an inpatient stay in a hospital or nursing facility. Meal delivery must be scheduled within 30 days of discharge event. Limited to four times per year.
Prior Authorization and/or doctor's referral (order) may be required for this benefit.
Acupuncture - Medicare Covered Benefit
$0 copay for acupuncture for chronic low back pain visits up to 20 visit(s) per year.