Cost Sharing

Copays


IMCare Classic (HMO SNP) members do not have copays for medical services. The chart below shows copays for prescription drugs. Copays may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Your Copay Amount for Tier 1


Generic Drugs is no more than: $0/$1.20/$3.30 (each prescription)

Your Copay for Tier 1- Brand Drugs


Is no more than: $0/$3.70/$8.25 (each prescription)

Deductibles


IMCare Classic (HMO SNP) members do not pay a deductible for Medicare-covered health care services or prescription drugs.

Premiums


You do not pay a separate monthly plan premium for IMCare Classic (HMO SNP). If you have Medical Assistance (Medicaid), you qualify for and are getting Extra Help to pay for your prescription drug premiums and costs. If you have questions about Extra Help, call one of the following:
  • 1-800-MEDICARE (1-800-633-4227, toll free). TTY users should call 1-877-486-2048 (toll free), 24 hours a day, 7 days a week.
  • The Social Security Office at 1-800-772-1213 (toll free), 7 a.m. to 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778 (toll free).
  • Your State Medicaid Office

View the LIS Premium Summary Chart (PDF) to see the premium for your plan.

Some plan members may be paying a premium for Medicare Part A and/or Medicare Part B. Many members do not pay premiums for Medicare Part A and/or Medicare Part B due to Medical Assistance (Medicaid) eligibility. If you are paying for your Medicare Part B, you must continue to pay your Medicare Part B premium. For full information about IMCare Classic benefits, call Member Services at 1-800-843-9536. TTY users can call 1-800-627-3529 or 711. Calls to these numbers are free. Hours are:

  • October 1 to February 14
    7 days a week, 8 a.m. to 8 p.m.
  • February 15 to September 30
    Monday to Friday, 8 a.m. to 8 p.m.

 

H2417 IMCARECLASSIC_114 CMS_Approved 04/04/2017
​Last Updated_04/05/2017