UCare Connect + Medicare (HMO D-SNP) 2021 Part D (Prescription Drug) Coverage
Members of UCare Connect + Medicare get Medicare Part D prescription drug coverage. This means that Medicare pays for part of their prescription drugs.
Our list of covered prescription drugs, also called a formulary, can be easily searched using our Formulary Search Tool. There is also an option to print the entire formulary.
The following prescription copays apply based on the person’s living situation and income level.
If you are in a nursing home, long-term care facility, or receiving home and community based services:
- You pay $0 for brand name drugs.
- You pay $0 for generic drugs.
If your income is at or below 100% of federal poverty guidelines:
- You pay $3.80 for brand name drugs.
- You pay $1.25 for generic drugs.
If your income is over 100% of federal poverty guidelines:
- You pay $8.50 for brand name drugs.
- You pay $3.40 for generic drugs.
After your yearly out-of-pocket drug costs reach $5,100, you will have no copay.
Generally, you must get your prescription drugs from contracted pharmacies in UCare’s network. To find out if your pharmacy is in UCare’s network, use the Search Network tool.
Because you have Medical Assistance, you qualify for Extra Help to pay for some of your prescription drug costs. For more information about Extra Help, call:
1-800-MEDICARE (1-800-633-4227), TTY/TDD users 1-877-486-2048 (24 hours a day/7 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.
Copays and coinsurance may vary based on the level of Extra Help received. Contact us for further details.
If you get Extra Help from Medicare, your monthly Part B premium and some prescription drug costs will be lower than what you would pay if you did not get Extra Help from Medicare. The amount of Extra Help you get will determine the cost of your monthly Part B premium.
Part D prescription drug benefit documents and information
UCare Connect + Medicare 2021 Formulary - List of Covered Drugs, Prior Authorization criteria and Step Therapy criteria.
Prescription Drug Claim Form
(PDF) (Updated 12/2020)
Request for Medicare Prescription Drug Coverage Determination Form (PDF) (Updated 12/2020)
Request for Redetermination of Medicare Prescription Drug Denial Form (PDF) (Updated 12/2020)
Prescription Drug Transition Policy (PDF) (Updated 12/2020)
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.
Mail order pharmacy program
UCare 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:
- Call in your prescriptions - Call 1-877-567-6320 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. When you call, please have your identification (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.
- Visit Express Scripts online - Go to Express-Scripts.com (external site) and follow the prompts.
- 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 Service at
612-676-6868 or 1-866-280-7202
8 am - 5 pm, Monday - Friday
UCare Connect + Medicare is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in UCare Connect + Medicare depends on contract renewal.