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Saint Paul, Minnesota2020 Summary of BenefitsUCare Medicare Plans Comparison GuideMetro
your shoppingchecklistWhy UCare?enroll in Original Medicareselect the plan that fits my lifestyleenroll in a UCare Medicare Advantage planenrollucare.org/medicare123by mailGet the peace of mind you deserve with UCare’sgreat coverage and affordable prices.phonesecure data transfercall 1-877-523-1518to enroll with alicensed MedicareSales Specialistsave enrollment to finishat later timecall a trusted UCarebroker near youfast and easyfill out the enrollmentform and mail it in thepostage-paid envelopeWe're the de-complicators. The Medicarefigure-outers who can tell you what you need toknow about Medicare and show you how to picka plan that's right for you.UCare is one of the longest serving MedicareAdvantage plans in Minnesota. Today, more than100,000 members trust us to provide theirhealth coverage.3 ways toonlineMedicare can feel overwhelming when you'retrying to figure it out on your own. UCare can help.ucare.org/medicare123 or call 1-877-523-15181
96%of all Minnesota providers in networkwith no referrals needed2020 Summary of BenefitsUCare Medicare Plans Comparison GuideWe’re theTOP CHOICEIN MINNESOTAfor individual Medicare Advantage plans*See what's inside:The ABC & D of MedicareChoosing the right plan for youTOP 11%ranking of plans nationwideearning 4 out of 5 stars*** BasedEnrollment informationPlan benefit detailsComparing plan benefitson membership as of January 2019.**Applies to 2020 plans. Every year, Medicare evaluates plans based on a 5-star rating system.This booklet gives you a summary of what we cover and what you pay. It doesn’t list every service thatwe cover or list every limitation or exclusion. Some services require preauthorization. To get a completelist of services we cover, call us and ask for the Evidence of Coverage.This information is not a complete description of benefits. Call 1-877-523-1518 or TTY 1-800-688-2534for more information.UCare Minnesota and UCare Health, Inc. are HMO-POS plans with Medicare contracts. Enrollmentin UCare Minnesota and UCare Health depends on contract renewal.2ucare.org/medicare123 or call 1-877-523-15183
Understanding the four parts of MedicaretheABC&Dof MedicareOriginal Medicare is made up of two parts — Part A and Part BPart A — hospital coverageMedicare Part A helps pay for inpatient hospital and skilled nursing facility stays, hospicecare and home health care.Part B — medical coverageMedicare Part B helps pay for a wide range of medical expenses including doctor visits,many preventive screenings, lab tests, X-rays, outpatient procedures, mental healthservices, durable medical equipment and more.Confused about Medicare? Our teamof de-complicators is at your service toanswer all your questions. We help youPart C — Medicare Advantage plannavigate so you can choose the healthThink of Part C (Medicare Advantage plan) asa package.plan that's right for you.It combines Part A with Part B, then may addspecial benefits that Medicare does not cover, suchas vision and dental care. Many packages eveninclude Part D prescription drug coverage.Additional coverageand servicesvision, hearing, dental,health & wellnessDiscover the all-in-one convenience of a MedicareAdvantage plan. Get all your health benefits in onepackage and find peace of mind in protecting yourhealth and managing your out-of-pocket costs.MedicareAdvantage planPart D — outpatient prescription drug coverageIf you want to know more about the coverage and costs of Original Medicare, look in your currentMedicare & You handbook. View online at medicare.gov or get a copy by calling 1-800-MEDICARE(1-800-633-4227), 24 hours a day, seven days a week. TTY users should call 1-877-489-2048.4Part D is available to anyone enrolled ineither Medicare Part A or Part B. Part D canbe purchased through two types of healthplans: Medicare Advantage plans that includePart D or stand-alone prescription drug plans.You must choose whether or not to enrollin Part D when you first become eligible forMedicare. Keep in mind that if you decline it,but decide you want this coverage later, youmay have to pay a penalty.Most Part D plans have a monthly premium,and benefits and drug costs that vary by plan.Each health plan publishes a list of covereddrugs called a formulary.ucare.org/medicare123 or call 1-877-523-15185
When am I eligible for Original Medicare?When can I make changes to my Medicare coverage?You qualify for Medicare if you:Annual Election Period (AEP) Are 65 or older or meet special criteria Are a citizen and permanent resident of the United StatesEvery year between October 15 and December 7, you can makea plan change to be effective on January 1 of the following year.This change may include adding or dropping Medicare Part D.Oct 15 – Dec 7Jan 1How do I enroll in Original Medicare?Note: Medicare Advantage plans release their rates and benefitsfor the following year on October 1.Annual ElectionPeriodCoveragebeginsYou may apply online at ssa.gov/medicare, via telephone appointment at1-800-772-1213 (TTY 1-800-325-0778), or in person at a local Social Security office.Special Enrollment Periods (SEPs) Worked for at least 10 years and paid Medicare taxes (or your spouse did)You may qualify for a Special Enrollment Period at any point during the year if you:When can I enroll in a Medicare Advantage plan? Are leaving or losing coverage through an employer or union (including COBRA)Medicare has limits to when and how often you can change your Medicare Advantage plan. Thesespecific time frames, called "election periods," determine when you can enroll in, or voluntarilydisenroll from, a Medicare Advantage plan. Move to an area where your current plan isn't offered Are on Medical Assistance or no longer qualify for Medical Assistance Receive Extra Help for Medicare Part D Are losing your current coverage or your plan is no longer offeredInitial Coverage Election Period (ICEP)When you become eligible for Medicare (either by age or disability), you may enroll in OriginalMedicare and a Medicare Advantage plan during your Initial Coverage Election Period (ICEP). Whenyou enroll during the ICEP, the soonest Medicare allows us to accept your enrollment application isthree months before you become eligible.Medicare Advantage Open Enrollment Period (MA-OEP)During the MA-OEP, Medicare Advantage members may enroll in another Medicare Advantage planor disenroll from their Medicare Advantage plan and return to Original Medicare (limited to onechange). This period runs from January 1 through March 31.If you have had Part A and are just applying for Part B, the ICEP is limited to the three months priorto your enrollment in Part B.Enroll when first eligibleYou have a seven‑month period (three months before you turn 65, the month you turn 65, andthree months after your birthday month).Examplebirthday is July 4AprMayJun3 months beforeJulyAugSeptOct3 months afterLate enrollment penaltiesIf you don’t sign up for Part B and Part D when you first become eligible, Medicaremay apply a penalty if you decide to sign up later. You'll pay the penalty for aslong as you have Part B and Part D coverage. Some exceptions apply.6ucare.org/medicare123 or call 1-877-523-15187
How to choose the right planUnderstand my costsWhat do I want to pay? Does it fit my budget? Copay: a set fee you pay for doctor/clinic visits or prescriptions Deductible: the initial amount you pay for health care servicesor prescription drugs before coverage begins Coinsurance: the percentage of costs you pay for covered services Monthly premium: the amount you pay each month for coverage Out-of-pocket maximum: the most you'll pay for coveredin-network medical expenses each yearUnderstand my health care needsWhat should I consider? I visit specialists and need a large network of doctors I'm healthy and only get yearly checkups I want extras, like fitness benefits and dental coverage I want my plan to include prescription drug coverageUnderstand which plan is best for meWhatever your health care needs, budget or lifestyle, UCare hasa plan for you. Get all the right benefits at the right price.8ucare.org/medicare123 or call 1-877-523-15189
UCare offers Medicareplans where you liveWhether you're in the Metro, North or South,UCare has a Medicare plan for you.UCare plans availablein Metro counties† UCare Prime (HMO-POS)*UCare Essentials Rx (HMO-POS)*UCare Complete (HMO-POS)*UCare Classic (HMO-POS)*UCare Total (HMO-POS)*UCare Value (HMO-POS)*Metro CountiesAnoka, Benton, Carver, Chisago, Dakota,Hennepin, Isanti, Mille Lacs, Ramsey, Scott,Sherburne, Stearns, Washington, WrightChoose from a range of plans and premiums.UCare has Medicare plans that include96% of all Minnesota providers.So you're covered in the city and at the lake.Statewide NetworkFor more information about plans available in other counties, please call a licensed MedicareSales Specialist at 1-877-523-1518, TTY 1-800-688-2534, 8 am – 5 pm, Monday – Friday.* (HMO-POS): Health Maintenance Organization with a Point‑of-Service contract.10ucare.org/medicare123 or call 1-877-523-151811
Picture yourself in one of our plansMarkJohnBettySuzanneDavidRickMark turns 65 nextmonth, is active and ingreat health. He doesn’twant to pay much for aMedicare Advantage Planbut wants good coveragein case of an emergencyor catastrophic illness.Mark is willing to pay highercost-sharing in exchangefor a 0 premium withUCare Prime.John is in good healthand doesn’t foresee anylarge expenses for healthcare. He wants a planthat gives him coveragein case an old injuryflares up, which is whyUCare Essentials Rx isa great fit. It providesall-in-one coverage thatincludes Part D at a lowpremium, plus dental.Betty is exploringMedicare Advantage planswith great coverage at amoderate premium. Shefinds the cap on annualout-of-pocket expensesquite appealing and isattracted by UCare’srobust benefits. Bettyplans to enroll in UCareComplete, an ideal fit forher budget and lifestyle.Suzanne is shopping fora comprehensive plan witha full suite of benefits andlittle or no out-of-pocketexpenses for each visit andprescription, plus dental. Inthe long run, she believesshe’ll save money andwon’t have to scrimp ongetting the health care sheneeds with UCare Classic.David is attracted tothe low out-of-pocketexpenses offered byUCare. David wants aplan that will leave himworry-free so he canfeel confident in hiscoverage. He is willingto pay a higher premiumfor UCare Total.Rick is a veteran whogets most of his care andall his prescriptions at theVA. He wants access to alarger network and theability to see a specialistof his choice. He is lookingfor dental and health clubcoverage and a plan withan affordable premium,like UCare Value.UCARE PRIMEUCARE ESSENTIALS RXUCARE COMPLETEUCARE CLASSICUCARE TOTALUCARE VALUEPremium 0 56 99 185 284 39Medical,Hospital PreventiveDental Options forComprehensiveDental FitnessPrograms Part DPrescriptionDrug Coverage Travel 12 ucare.org/medicare123 or call 1-877-523-151813
UCare provider network andprescription drug coverageAre yours included?Is my doctor in the network?Are my prescription drugs covered?Find a doctorFind a drugSearch for a full list of providers (including specialists, hospitals,dentists and chiropractors) at ucare.org/medicare123, click"find a doc, find a drug."Search our list of covered drugs at ucare.org/medicare123, click"find a doc, find a drug."If you prefer, call for help or to request a Provider and PharmacyDirectory at 1-877-523-1518.If you prefer, use the printed 2020 list of covered drugs (formulary)provided. Check the alphabetical index in the back of the formularyto find your drugs.96% of all Minnesota providers in networkincluding Allina Health, M Health Fairview, Park Nicollet, North Memorial Health,Essentia Health, Stillwater Medical Group, Voyage Healthcare, Sanford Health,Entira Family Clinics, Mayo Clinic and many more with no referrals needed14ucare.org/medicare123 or call 1-877-523-151815
What are my prescriptiondrug options?Fill your prescriptions at one of more than 60,000 preferred and standard pharmaciesin your plan network. You'll save more when you use preferred pharmacies, includingmail order.Preferred Pharmacies Value — Pay less for your medications when you use a preferred network pharmacy Choice — Choose from more than 23,000 preferred pharmacies, includingCVS/Target, Costco, Cub Foods and Sam's Club/Walmart Express Scripts mail order — Safe and convenient, plus you can get a 90-day supplyfor two copays. Learn more about Express Scripts in your new member packet.To find a preferred pharmacy in your plan network, use the online search toolat ucare.org/medicare123.If you prefer, call for help or request a Provider and Pharmacy Directoryat 1-877-523-1518.What about fitness benefitsand discounts?SilverSneakers Fitness ProgramHealth Club Savings ProgramWhether you’re close to home ortraveling, you can use yourSilverSneakers membership howeverand whenever it works for you.This fitness program includes:Join a class, work with weights, swimsome laps, or try something new.Health Club Savings offers the varietyyou want and the flexibility you deserve.If you belong to a participating healthclub that is not in the SilverSneakersnetwork, you can receive areimbursement of up to 20 in yourmonthly health club membership fees. A free basic fitness membership atmore than 16,000 locations in theSilverSneakers network Online support SilverSneakers FLEX fitness classes At-home fitness kit options for stressrelief, strength, walking and yogaHow it worksTo find clubs and classes where youlive or travel, visit silversneakers.comor call 1-888-423-4632, Monday – Friday,7 am – 7 pm CT.How it worksBring your UCare member IDcard to your health club tosign up. To see a full list ofparticipating health clubs,visit ucare.org/healthwellnessTivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarksof Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. 2019 Tivity Health, Inc. All rights reserved.Community Education DiscountGet up to a 15 discount on most Minnesota community education classes, likecooking or learning a new language. Check your local community education catalog orcontact the local school district for class times and locations. Limit of three discountsin a calendar year (one discount per class enrollment).16ucare.org/medicare123 or call 1-877-523-151817
EnrollmentChoose a clinicUCare Medicare PlansGet all your health benefits in one planSelect a primary care clinic from the PrimaryCare Clinic Listing found in your packet. Withinthis clinic, you may see any doctor. You may seeany specialist in our network without a referral.Forms by mailWe must receive your enrollment applicationby (not postmarked by) the end of the monthprior to when you want coverage to start (exceptduring the Annual Election Period — must bereceived by 12/7 for a 1/1 effective date).Once we receive your enrollmentapplication, you: may receive a call from us if any requiredinformation is missing from the enrollment formtravel coverageprescription drugcoveragevision benefits3 ways toenrollucare.org/medicare123fast and easyonlinesecure data transfersave enrollment tofinish at later time will get a letter within 15 days to verifyyour enrollment may receive a letter from us if you did nothave a Medicare Part D plan from the dateyou were first eligible may receive a letter from us if you are leavingan employer group plan to join our plan will get a new member packetby mailfill out the enrollmentform and mail it in thepostage-paid envelope will get a UCare member identification cardthat you can begin using on your effective datefitness optionsdental coveragehearing benefitsShould you require medical services orprescription drugs before you receive yourID card, please call Customer Service at1-877-523-1515 (TTY 1-800-688-2534).How to pay your premiumsYou can choose to pay your premium by: monthly check by mailphonecall 1-877-523-1518to enroll with alicensed MedicareSales Specialistcall a trusted UCarebroker near you automatic payment/Electronic FundsTransfer (EFT) Social Security or Railroad RetirementBoard withdrawalYou cannot charge your premium to a creditcard. Please do not send money with yourenrollment form.18ucare.org/medicare123 or call 1-877-523-151819
Choose the plan that fits your lifestylePlan benefit detailsBENEFITSUCARE PRIMEUCARE ESSENTIALS RXUCARE COMPLETEUCARE CLASSICUCARE TOTALUCARE VALUE2020 monthly premium (you must continue topay your Medicare Part B premium) 0 56 99 185 284 39Medical deductible 0 0 0 0 0 0Part D deductibleTier 1 0Tiers 2–5 435Tier 1 0Tiers 2–5 400Tiers 1 & 2 0Tiers 3–5 250Tiers 1 & 2 0Tiers 3–5 225Tiers 1 & 2 0Tiers 3–5 100Not coveredOut-of-pocket maximum 5,000 3,400 3,000 3,400 3,400 3,400The most you will pay out‑of‑pocket for in-networkMedicare-covered services each year. ExcludesMedicare Part D and all other non‑Medicarecovered services and premium.Once you have paid thisamount, you are coveredat 100% for benefits forthe remainder of thecalendar yearOnce you have paid thisamount, you are coveredat 100% for benefits forthe remainder of thecalendar yearOnce you have paid thisamount, you are coveredat 100% for benefits forthe remainder of thecalendar yearOnce you have paid thisamount, you are coveredat 100% for benefits forthe remainder of thecalendar yearOnce you have paid thisamount, you are coveredat 100% for benefits forthe remainder of thecalendar yearOnce you have paid thisamount, you are coveredat 100% for benefits forthe remainder of thecalendar year 300 copay per day(days 1 –5); then100% covered 300 copay per day(days 1–5); then100% covered 150 copay per day(days 1–5); then100% covered 250 copay per stay(not per day); then100% covered 100 copay per stay(not per day); then100% covered 400 copay per stay(not per day); then100% coveredOutpatient hospital or procedure 395 copay 300 copay 250 copay 150 copay 0 copay 250 copayAmbulatory surgery center 395 copay 300 copay 250 copay 150 copay 0 copay 250 copayPrimaryIn-network 25 copayOut-of-network 25 copayIn-network 20 copayOut-of-network 20 copayIn-network 0 copayOut-of-network 0 copayIn-network 0 copayOut-of-network 0 copayIn-network 0 copayOut-of-network 0 copayIn-network 0 copayOut-of-network 0 copaySpecialistIn-network 50 copayOut-of-network 50 copayIn-network 45 copayOut-of-network 45 copayIn-network 35 copayIn-network 20 copayOut-of-network 35 copay Out-of-network 20 copayIn-network 10 copayOut-of-network 10 copayIn-network 35 copayOut-of-network 35 copayHospital CareInpatient hospital care (per admission)Your hospital status, meaning whether thehospital considers you an "inpatient" or"outpatient," affects how much you pay for hospitalservices. Inpatient hospital care copays apply if youare admitted to the hospital with a doctor’s order.Doctor VisitsIn general, out-of-network cost-sharing in the U.S. is 30% for UCare Prime and 20% for other plans;cost-sharing is the same both in and out-of-network for some services.20ucare.org/medicare123 or call 1-877-523-151821
BENEFITSUCARE PRIMEUCARE ESSENTIALS RXUCARE COMPLETEUCARE CLASSICUCARE TOTALUCARE VALUENot coveredIn-network 0 copayOut-of-network NotcoveredIn-network 0 copayOut-of-network NotcoveredIn-network 0 copayOut-of-network NotcoveredIn-network 0 copayOut-of-network NotcoveredIn-network 0 copayOut-of-network NotcoveredPreventive CareRoutine physical examFor the next 11 benefits, the 0 copay applies in-network and out-of-network for all six plans."Welcome to Medicare" preventive visit(if in the first 12 months on Part B) 0 copay 0 copay 0 copay 0 copay 0 copay 0 copayAnnual Wellness Exam(if you had Part B for more than 12 months) 0 copay 0 copay 0 copay 0 copay 0 copay 0 copayImmunizatio
1-800-772-1213 (TTY 1-800-325-0778), or in person at a local Social Security office. When can I enroll in a Medicare Advantage plan? Medicare has limits to when and how often you can change your Medicare Advantage plan. These specific
