UCare Prime (HMO-POS)
Medicare Plan Details
2021 Plan
Monthly Premium
(select county for price) |

by UCare
Additional Coverage
Hearing
Vision
Dental
Overall Government Star Rating
4.5out of 5 stars
State: Minnesota
Select your county to view the price for this plan
Plan Type
Medicare Advantage (Part C) with Prescription Drug (Part D)
Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D
Plan Details
$0
$0
$0
$0
$5,500 In-network
$7,500 Out-of-network
$7,500 Out-of-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
In-network: $25 copay per visit
Out-of-network: $25 copay per visit
Out-of-network: $25 copay per visit
In-network: $50 copay per visit
Out-of-network: $50 copay per visit
Out-of-network: $50 copay per visit
Tests, labs, & imaging
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
$90 copay per visit (always covered)
$45 copay per visit (always covered)
Hospital Services
In-network: $300 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 30% per stay
$0 per day for days 6 through 90
Out-of-network: 30% per stay
In-network: $395 copay per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-network: 30% per stay
$184 per day for days 21 through 100
Out-of-network: 30% per stay
Preventive services
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
In-network: $300 copay
Out-of-network: $300 copay
Out-of-network: $300 copay
Therapy services
In-network: $40 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
In-network: $40 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Mental health services
In-network: $40 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
In-network: $40 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
In-network: $40 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
In-network: $40 copay
Out-of-network: $40 copay
Out-of-network: $40 copay
Opioid treatment services
Covered
Other services
In-network: 20% coinsurance per item
Out-of-network: No Data
Out-of-network: No Data
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Out-of-network: 30% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase | Catastrophic coverage phase |
---|---|---|---|
Preferred Generic | $12.00 copay |
Brand-name drugs :
|
Brand-name drugs :
|
Generic | $20.00 copay | ||
Preferred Brand | 25% | ||
Non-Preferred Drug | 50% | ||
Specialty Tier | 25% |
Part B Drugs
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Extra Benefits
Hearing
In-network: $50 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: No Data
Out-of-network: No Data
In-network: $699-999 copay
Out-of-network: No Data
Out-of-network: No Data
Preventive Dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
In-network: $0 copay
Out-of-network: No Data
Out-of-network: No Data
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Not covered
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other benefits
Limited coverage
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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