2022 UCare Prime (HMO-POS)

UCare Prime (HMO-POS) H2459-020 is a 2022 Medicare Advantage Plan or Part-C by UCare available to residents in Minnesota. This plan includes additional prescription drug (Part-D) coverage. The UCare Prime (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $6,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,000 out-of-pocket. This can be a extremely nice safety net.

UCare Prime (HMO-POS) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

UCare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for UCare Prime (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from UCare and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from UCare except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 UCare Medicare Advantage Plan Costs

UCare Prime (HMO-POS) Part-C Premium

UCare charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H2459-020 Part-D Deductible and Premium

UCare Prime (HMO-POS) has a monthly drug premium of $0.00 and a $480.00 drug deductible. This UCare plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by UCare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

UCare Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This UCare plan does not offer additional coverage through the gap.

H2459-020 Formulary or Drug Coverage

UCare Prime (HMO-POS) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 UCare Prime (HMO-POS) H2459-020 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$3	$12
Tier 2	$10	$20
Tier 3	17%	25%
Tier 4	50%	50%
Tier 5	25%	25%

*Initial Coverage Phase and 30 day supply

2021 UCare Prime (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	$0 copay
Diagnostic services	$0 copay (Out-of-Network)
Endodontics	$0 copay (Out-of-Network)
Endodontics	$0 copay
Extractions	$0 copay
Extractions	$0 copay (Out-of-Network)
Non-routine services	$0 copay (Out-of-Network)
Non-routine services	$0 copay
Periodontics	$0 copay
Periodontics	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay
Restorative services	$0 copay (Out-of-Network)

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	20% coinsurance
Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic tests and procedures	20% coinsurance
Diagnostic tests and procedures	30% coinsurance (Out-of-Network)
Lab services	$0 copay
Lab services	$0 copay (Out-of-Network)
Outpatient x-rays	20% coinsurance
Outpatient x-rays	30% coinsurance (Out-of-Network)

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Doctor Visits

Primary	$25 copay per visit
Primary	$25 copay per visit (Out-of-Network)
Specialist	$50 copay per visit
Specialist	$50 copay per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$45 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$50 copay (Out-of-Network)
Foot exams and treatment	$50 copay
Routine foot care	Not covered

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Ground Ambulance

$300 copay
$300 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Hearing aids	$699-999 copay
Hearing exam	30% coinsurance (Out-of-Network)
Hearing exam	$50 copay

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Inpatient Hospital Coverage

$300 per day for days 1 through 5 $0 per day for days 6 through 90
30% per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	20% coinsurance per item
Diabetes supplies	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$300 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$40 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	$40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay (Out-of-Network)

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MOOP

$5,500 In-network $7,500 Out-of-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$395 copay per visit
30% coinsurance per visit (Out-of-Network)

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Preventive Care

$0 copay (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	$0 copay (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Oral exam	$0 copay (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$40 copay (Out-of-Network)
Occupational therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$40 copay (Out-of-Network)

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Skilled Nursing Facility

30% per stay (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$0 copay
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for UCare Prime (HMO-POS) H2459

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in UCare Prime (HMO-POS) Plans Performance

Health Plan Customer Service Rating for UCare Prime (HMO-POS)

UCare Prime (HMO-POS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

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Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for UCare Prime (HMO-POS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.