$332.00 monthly / GroupUCare for Seniors Core Option
$155.00 monthly / Group UCare for Seniors Basic Option
$65.00 monthly
Network / Must choose a primary care clinic, however, you do not need a referral to see a specialist within the network
UCare’s Provider network includes Allina, CentraCare, Essentia, Fairview, HealthEast, HCMC, Mayo, North Memorial, Park Nicollet, U of M, and many more.
Medicare / Must have Parts A and B of Medicare
Residency Requirements / Must reside within the service area which consists of the entire State of Minnesota and 26 Western Wisconsin counties.
Service Area / Service area includes: All of Minnesota and the following 26 counties in Western Wisconsin: Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Iowa, Jackson, Juneau, La Crosse, Monroe, Pepin, Pierce, Polk, Richland, St. Croix, Sauk, Sawyer, Trempealeau, Vernon and Washburn.
Prescription Drugs
(30-day supply, formulary) / $50 annual deductible
$10 copay - Generic Rx
$40 copay - Preferred Brand Rx
$80 copay - Brand Rx
32% coinsurance – Specialty
Mail order only: 2 copays for 90-day supply.
No Coverage Gap (donut hole). Medicare catastrophic begins once the out-of-pocket of $4,950 is met. / $100 annual deductible
$15 copay - Generic Rx
$45 copay - Preferred Brand Rx
$90 copay - Brand Rx
31% coinsurance – Specialty
Mail order only: 2 copays for 90-day supply.
Once total yearly Rx costs reach $3,700, you pay $15 copay for generic 40% for Brand Name drugs until the out of pocket cost of $4,950 is met.
Catastrophic coverage begins at that time. / $200 annual deductible
$15 copay - Generic Rx
$45 copay - Preferred Brand Rx
$90 copay - Brand Rx
29% coinsurance – Specialty
Mail order only: 2 copays for 90-day supply.
Once total yearly Rx costs reach $3,700, you pay 51% for generic & 40% for Brand Name drugs until the out of pocket cost of $4,950 is met.
Catastrophic coverage begins at that time.
Medicare Part B Medications / 80% / 80% / 80%
Preventive Care
(Routine physicals, cancer screenings, eye and hearing exams, immunizations). / 100% Coverage
Group UCare for Seniors High Option
$332.00 monthly / GroupUCare for Seniors Core Option
$155.00 monthly / Group UCare for Seniors Basic Option
$65.00 monthly
Eyewear & Hearing Aids / Eyewear - $75 annual allowance – High and Core options only.
Hearing Aid Benefit - $500 every 36 months – High & Core Options only.
Office Visits / Primary - $15 copay
Specialist - $15 copay / Primary - $15 copay
Specialist - $30 copay / Primary - $15 copay
Specialist - $40 copay
Lab & X-rays / 100% coverage / 100% coverage / 10% coinsurance
Inpatient Hospital / 100% after $100 copay per admission / 100% after $200 copay per admission / $300/day copay for days 1-5; then 100%
Outpatient Surgery / 100% after a $200 copay / 100% after a $250 copay / 100% after a $250 copay
Emergency Care (Worldwide) / $50 copay per hospital emergency / $75copay per hospital emergency / $75copay per hospital emergency
SNF / 100% coverage for days 1 -20
$100 copay per day for days 21 -100
No 3 day inpatient hospital stay required for coverage.
Out of Pocket Maximum / $3400 per calendar year for Part A and B Services.
Dental / Preventive Dental – 100% coverage; 2 exams, 3 cleanings plus annual bite-wing x-rays at participating providers. Classic Choice dental may be added for $22/mo.
Travel Benefit Option / May live outside of the service area for up to 6 months a year. Coverage for non-emergencies outside the
UCare for Seniors network is 80%.
Fitness / SilverSneakers® Fitness Program – Members get free and flexible membership to health classes at Community Centers, the YMCA, LA Fitness, Anytime Fitness and many more including 13,000 nationwide clubs to use when you travel. Check out Silversneakers.com.
UCare Health Club Savings Program – Receive up to a $20 reimbursement for membership in participating clubs such as
Lifetime Fitness.
This is a brief summary of benefits. Not all covered services, exclusions, and limitations are shown here. Please call the UCare benefit team at 612-676-6900 or
1-877-598-6574 for specific information, or visit