UCare Medicare 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.

UCare'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 Medicare.gov and Social Security Administration websites (external sites).

Part D prescription drug benefit documents and information

UCare Medicare 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 - UCare Medicare (PDF)
Prescription Drug Transition Policy - UCare Medicare w/ Fariview & North Memorial (PDF)

Medication Therapy Management Program - UCare Medicare ​ (PDF)
Medication Therapy Management Program - UCare Medicare w/ Fairview & North Memorial (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.

 

These tables shows you what your 2019 UCare monthly plan premium will be if you get Extra Help. This does not include any Medicare Part B premium you may have to pay. Choose your region from the tabs above to see the premium costs with Extra Help.

Health care costs can vary depending on the area in which you live. Our coverage area is divided into three regions based on counties: north, south and metro. Find your county on the map of UCare Medicare regions or in the list below to find our which region you are in.

North
Aitkin
Becker
Beltrami
Carlton
Cass
Clay
Clearwater
Cook
Crow Wing
Douglas
Grant
Hubbard
Itasca
Kanabec
Kittson
Koochiching


Lake
Lake of the Woods
Mahnomen
Marshall
Morrison
Norman
Otter Tail
Pennington
Pine
Polk
Red Lake
Roseau
St. Louis
Todd
Wadena
Wilkin

Metro
Anoka
Benton
Carver
Chisago
Dakota
Hennepin
Isanti
Mille Lacs
Ramsey
Scott
Sherburne
Stearns
Washington
Wright

South
Big Stone
Blue Earth
Brown
Chippewa
Cottonwood
Dodge
Faribault
Fillmore
Freeborn
Goodhue
Houston
Jackson
Kandiyohi
Lac qui parle


Le Sueur
Lincoln
Lyon
Martin
McLeod
Meeker
Mower
Murray
Nicollet
Nobles
Olmsted
Pipestone
Pope
Redwood


Renville
Rice
Rock
Sibley
Steele
Stevens
Swift
Traverse
Wabasha
Waseca
Watonwan
Winona
Yellow Medicine

 

This table shows you what your 2019 UCare monthly plan premium will be if you get Extra Help.

Your level of
Extra Help
Prime Essentials Rx Complete Classic Total Care
Core
Care
Advantage
100% $0.00 $31.70 $69.00 $145.40 $214.20 $8.90 $101.20
75% $0.00 $37.80 $76.50 $154.00 $223.20 $15.90 $110.20
50% $0.00 $43.80 $84.00 $162.70 $232.10 $22.90 $119.10
25% $0.00 $49.90 $91.50 $171.30 $241.10 $30.00 $128.10

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

 

This table shows you what your 2019 UCare monthly plan premium will be if you get Extra Help.

Your level of
Extra Help
Essentials Rx Classic Total
100% $43.70 $171.20 $259.20
75% $49.80 $180.20 $268.20
50% $55.80 $189.10 $277.10
25% $61.90 $198.10 $286.10

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

 

This table shows you what your 2019 UCare monthly plan premium will be if you get Extra Help.

Your level of
Extra Help
Complete Classic Total
100% $99.00 $181.20 $264.20
75% $106.50 $190.20 $273.20
50% $114.00 $199.10 $282.10
25% $121.50 $208.10 $291.10

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

Mail order pharmacy program

UCare Medicare members 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 Express-Scripts.com (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.


Questions?

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

1-877-523-1515 toll free
TYY: 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.


H0422_Y2459_092718_7_M CMS Accepted (10012018)
September 2018