EssentiaCare 2021 Part D (Prescription Drug) Coverage

Do you qualify for Extra Help with your prescription drug costs?

If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium with UCare will be lower than what it would be if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine your total monthly plan premium as a member of our plan.

EssentiaCare's premium includes coverage for both medical services and prescription drug coverage.

If you aren't getting Extra Help, you can see if you qualify by calling:

  • 1-800-MEDICARE (1-800-633-4227), TTY/TDD users 1-877-486-2048 (24 hours a day/ days a week)
  • Your state Medicaid Office, or
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778.

You can also find information on the and Social Security Administration websites (external sites).

Part D prescription drug benefit documents and information

EssentiaCare Formulary - List of Covered Drugs, Prior Authorization criteria and Step Therapy criteria.

Prescription Drug Calculator (external site)

Prescription Drug Claim Form (PDF)
Request for Medicare Prescription Drug Coverage Determination Form (PDF)
Request for Redetermination of Medicare Prescription Drug Denial Form (PDF) Updated 12/2018

Prescription Drug Transition Policy (PDF)

Medication Therapy Management Program ​ (PDF) - available to all Medicare-eligible members who meet program criteria. While not a part of a prescription drug benefit, it is a Medicare designed program sponsored by UCare.


This table shows you what your 2021 UCare monthly plan premium will be if you get Extra Help:

Your level of
Extra Help
Monthly premium* -
Monthly premium* -
100% $28.90 $91.80
75% $32.70 $100.10
50% $36.40 $108.40
25% $40.20 $116.70






*This does not include any Medicare Part B premium you may have to pay.

Mail order pharmacy program

EssentiaCare members with Medicare may order up to a 90 day supply on certain medications to be delivered by mail through Express Scripts, UCare’s Pharmacy Benefits Manager. Besides convenience, benefits include free home delivery and 24/7 access to a pharmacist.

Choose one of these ways to start receiving your medications at home:

  1. Call in your prescriptions - Call 1-877-567-6320 (toll free) to speak with an Express Scripts patient care advocate who can help you get started with Home Delivery. Hours of operation are 24 hours a day, 7 days a week. TTY/TDD users should call 1-800-716-3231 (toll free). When you call, please have your ID number (found on your member ID card), your doctor's name and phone number, and a list of your current medications or medicine containers.
  1. Visit Express Scripts online - Go to (external site) and follow the prompts.
  2. Ask your provider to contact Express Scripts Mail Order.


Medicare Savings Programs (external site)
Use this tool to find out which programs can help you.

Best Available Evidence Policy (external site)

Coverage Determinations, Appeals, and Grievances
Find out how to make a complaint if you have concerns about your Part D coverage.


If you have any questions, please call UCare's Customer Services at

1-877-523-1515 toll free
TTY 1-800-688-2534 toll free

24 hours a day, seven days a week

This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.

U6681 10/2020