Frequently Asked Questions about Your Coverage

Claims and Billing

You do not need to take any action. This letter is sent any time a claim is denied in UCare's claim system. It is required by Medicare and Medicaid that this letter be sent to both the member and the doctor's office regardless of the denial reason. It is also possible that your doctor's office will share this letter with you.

If you want to learn more, you can contact your doctor's office to verify it has resolved the issue with UCare.

Your UCare Medicare premium is deducted on the 8th of the month unless it is a holiday or a weekend then it’s the first business day after the 8th.

Your Individual & Family Plans premium is deducted on the 20th of the month (prior to the coverage month – example February premium is deducted on January 20th) unless it is a holiday or a weekend then it’s the first business day after the 20th.

Congratulations! We want this change to go smoothly for you. If you are currently covered by an individual or family plan that you purchased through MNsure, to avoid paying two premiums, be sure to cancel your coverage before your Medicare coverage begins.

To end your coverage, contact MNsure at least one month before you want your coverage to end. This gives MNsure time to process your request. Call MNsure at 651-539-2099 (1-855-366-7873 toll free).

Remember, you will need to cancel your UCare plan by calling MNsure even if you move to a UCare Medicare plan.

Medicare Prescriptions

Medicare Part D is a voluntary outpatient prescription drug program available to anyone who is enrolled in Medicare Part A or Part B. It helps Medicare beneficiaries pay for their prescription drugs. There are three stages of coverage:

  • Stage 1: Initial Coverage Stage - You pay your share of the cost for your drugs and UCare pays its share. Your cost is based on the prescription deductible and may include coinsurance or different copay amounts for “tiers” of drugs. You stay in this stage until your payments for the year, plus UCare’s payments, reach the initial coverage stage limit set by Medicare for the year.
  • Stage 2: Coverage Gap Stage - You pay a part of the cost for your drugs until you reach a limit set by Medicare for the year. Your cost will differ for brand-name vs. generic drugs and may include coinsurance or different copay amounts for “tiers” of drugs.
  • Stage 3: Catastrophic Coverage Stage - Once you have reached the limit described in stage 2 set by Medicare, you enter the Catastrophic Coverage Stage. UCare will pay most of the cost of your covered drugs for the rest of the calendar year. You pay the greater of a low copay or coinsurance (set by Medicare) for drugs for the remainder of the year.

Not all plans have the same deductible or copays for drug tiers. See your Summary of Benefits for specifics and for the Medicare coverage limits set each year.

UCare Medicare members have several options for lowering prescription costs:

  1. Drug tier changes: If your medication falls in a tier 4 or a tier 2, it may be eligible to be reviewed for a tiering exception. If approved, the cost of your drug would be lowered to the tier below, in turn lowering your copay. To start the tiering exception process, your provider can either contact Express Scripts (ESI) at 877-558-7521 or send an exception form to UCare.
  2. Financial assistance: You may also apply and qualify for Low Income Cost Sharing (LICS). To find out if you qualify, contact Medicare at 1-800-633-4227 or visit the Medicare website for information.
  3. Patient assistance programs: Certain drugs have patient assistance programs that can help pay for a particular medication. To find out if your drug qualifies, contact UCare's Customer Services.
  4. Generic prescriptions: If you are taking a brand name drug, contact your doctor to see if there is a generic alternative for the medication. Keep in mind not all brand name medications have generic substitutes.

Special Coverage Requests

UCare may require your doctor to send us information about why a service or prescription is medically necessary to determine if it will be covered. This process is called prior authorization. Members are not responsible for getting prior authorization; it is your doctor’s responsibility.

  • For prescription authorizations, your doctor's office should contact Express Scripts.
  • For other services requiring prior authorization, your doctor's office can contact UCare’s Provider Assistance Center.

UCare’s Network

There are several ways you can search for doctors in UCare’s network.

  1. Use the Search Network tool to locate the most up-to-date information. You can search for a network doctor, pharmacy, dentist, or chiropractor.
  2. Get assistance from UCare’s Customer Services. A representative will happy to help research and confirm providers within UCare’s network.
  3. Consult your provider directory. UCare mails a provider directory to all new members, and Medicare members receive a new directory every three years. Call UCare’s Customer Services to request a print directory.

 

Plan Materials

It is a Medicare requirement that we send annual updates and required information to each member enrolled in an individual plan such as UCare Medicare. This ensures you and your spouse stay informed of any updates or changes with your health care coverage.

Member Site

To help keep our members’ information as secure as possible, we require each individual member to register for the secure member site separately. This ensures your private health information and claims are only accessible by you, and helps minimize the risk of error when entering your information.

Travel and Other Coverage

UCare Medicare plans offer out of state coverage.

  • UCare Medicare plans cover Emergency Care and Urgent Care the same as within the state. Many other services are covered out of state at 80% (you pay the other 20%), as long as the provider is Medicare-certified. Please refer to your Evidence of Coverage (EOC) or call Customer Services for more detailed information.
  • Prescriptions are covered throughout the United States as long as they are filled at a contracted UCare pharmacy provider.

Minnesota Health Care Program are covered out of state for Emergency and Urgent Care services. Individual & Family Plans members are covered out of state for Emergency services. All other services are not covered unless UCare makes an exception.

UCare Medicare plans cover chiropractic, hearing, and vision services. For more specific details on how these services are covered, please refer to your Evidence of Coverage (EOC) or contact Customer Services. Some UCare Medicare plans also include dental coverage. Members of the Classic plan may enroll in a separate comprehensive dental package for additional coverage.

Minnesota Health Care Programs cover dental, chiropractic, hearing, and vision services. To learn more about coverage levels and benefit limits, please consult your Evidence of Coverage or call Customer Services.

Individual & Family Plans offer dental coverage for children.

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