EssentiaCare 2024 Part D (prescription drug) coverage
Do you qualify for Extra Help with your prescription drug costs?
If you get Extra Help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium with UCare will be lower. The amount of Extra Help you get will determine your total monthly plan premium as a member of our plan.
EssentiaCare's premium includes coverage for both medical services and prescription drug coverage in many plan options.
If you aren't getting Extra Help and have limited resources, you can find out if you qualify by calling:
- 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.
You can also find information on the Medicare.gov and Social Security Administration websites.
Part D prescription drug benefit documents and information
EssentiaCare Formulary - List of Covered Drugs, Prior Authorization criteria and Step Therapy criteria.
Prescription Drug Claim Form (PDF)
Request for Medicare Prescription Drug Coverage Determination Form (PDF)
Request for Redetermination of Medicare Prescription Drug Denial Form (PDF)
Prescription Drug Transition Policy (PDF)
Medication Therapy Management (MTM)
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.
UCare Medicare Part D information
UCare Advocate Part D information
This table shows you what your 2024 EssentiaCare monthly plan premium will be if you get Extra Help:
| Your level of Extra Help | Secure | Grand | Access |
| 100% | $12.40 | $70.40 | $0.00 |
| 75% | N/A | N/A | N/A |
| 50% | N/A | N/A | N/A |
| 25% | N/A | N/A | N/A |
Note: This does not include any Medicare Part B premium you may have to pay.
Due to the Inflation Reduction Act, all members who were previously eligible for partial LIS benefits are now eligible for full LIS benefits, including premium subsidies. Therefore, there is no 25, 50, or 75% amount displayed due to this act.
Mail order pharmacy program
Beginning in 2024, Costco Mail Order Pharmacy will be our network mail order delivery program. Save time with free home delivery from Costco Mail Order Pharmacy and you don’t need to be a Costco member to use this service. You may order an extended day supply of some medications and it may cost less than at a retail pharmacy.
Before Costco Mail Order Pharmacy can begin filling your prescriptions, you will need to have or create a Costco account and create a Costco Mail Order Pharmacy patient profile. Go to the Costco Mail Order Pharmacy website and click “Get Started” or call 1-800-607-6861 (TTY users call 711). You will need your pharmacy billing information — RxBIN, RxPCN and Rx Group — found on your 2024 member identification (ID) card to complete the patient profile.
Once you have an account and patient profile, choose one of these ways to start getting your drugs at home:
- Call in your prescriptions at 1-800-607-6861 (TTY users call 711).
- Submit your prescriptions at pharmacy.costco.com.
- Ask your provider to contact Costco Mail Order Pharmacy.
For refills of your mail order prescriptions, you have the option to sign up for an automatic refill reminder program. Typically, you should expect to receive your prescription drugs within 14 days from the time the mail order pharmacy receives the order.
Additional resources
Best Available Evidence Policy
Coverage Determinations Appeals and Grievances
Find out how to make a complaint if you have concerns about your Part D coverage.
This information is not a complete description of benefits. Contact the plan for more information. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.