Medicare FAQs

Medicare is a national health insurance program for most people who are age 65 and older, or who meet special criteria. "Original Medicare" has two parts: Part A hospital insurance and Part B medical insurance. Most people do not have to pay a monthly premium for Part A, but will need to pay a monthly premium for Part B. If you are not already receiving Social Security benefits, you won't be automatically enrolled in Medicare. You'll need to sign up.

No. You are eligible for Medicare at age 65 regardless of whether or not you're receiving Social Security income.

Medicare Part C, also known as Medicare Advantage plans, are available through private insurance companies that contract with Medicare to provide Medicare Part A and Part B benefits. Most Medicare Advantage plans include Part D outpatient prescription drug coverage and they often include extras like vison, hearing, dental and fitness benefits.

Medicare Part D outpatient prescription drug coverage is optional and helps pay for prescription drugs. It is available through private insurance companies to anyone enrolled in Medicare Part A or Part B. You can enroll through a stand-alone prescription drug plan (PDP) or a Medicare Advantage plan that includes Medicare Part D, known as an MA-PD.

If you choose not to enroll in Part D when you first become eligible, you will have an opportunity to enroll during the next Annual Election Period (Oct. 15 through Dec. 7 of each year for a Jan. 1 effective date). You may also be required to pay a late enrollment penalty of 1% of the national base beneficiary premium for each full, uncovered month that you were eligible to enroll in a Part D plan but did not do so. This penalty is applied monthly and continues for as long as you have Part D coverage.

The penalty would not be applied in some situations, like if you qualify for Medicare Part D Extra Help or if you have maintained creditable drug coverage. Creditable drug coverage means that it is as good as or better than that offered in Medicare Part D plans. This includes drug coverage through Veterans Affairs and prescription drug coverage offered by many employer group plans.

Many Medicare Advantage plans come with Part D drug coverage. You can also choose to get your Part D coverage through a separate plan that covers only your prescription drugs.

Yes, to be eligible you must:

• Have Medicare Part A and Part B
• Reside in the service area

No physical exam or other health screening is required. You must enroll within a valid election period.

A set fee you pay for a medical service or prescription (e.g., $100 copay for an emergency visit).

The amount you pay for a medical service or prescription, usually expressed as a percentage (e.g., 20% coinsurance for an office visit).

The amount you must pay for health care services or prescriptions before Original Medicare, your Medicare health plan or prescription drug plan begins to pay.

The most you have to pay for in-network covered medical services in a plan year.

Plans sold by private insurance companies that help pay some of the costs (“gaps”) Original Medicare doesn’t cover, such as the Medicare Part A deductible, and your copays or coinsurance when you get care.

These plans do not include Medicare Part D.

The Centers for Medicare & Medicaid Services (CMS) created a Five Star Quality Rating System that rates Medicare Advantage (MA) and Prescription Drug (PDPs or Part D) plans every year. Ratings are between 1 and 5 (5 being the highest) for health plan quality based on measurements of customer satisfaction and the quality of care the plan delivers. See UCare Star Rating information.

To find all Medicare plans available in your area, visit medicare.gov or call a local Medicare insurance broker. You also can ask relatives and friends about their Medicare plans, including how satisfied they are with with things like customer service and bill payment.

You can shop and compare UCare's Medicare plans online, get a free information kit mailed to you or talk with a Medicare de-complicator at 1-866-311-6521.

You can enroll in any of the following ways:

• Complete and mail a paper enrollment form
• Online through our shop and compare tool or at medicare.gov (UCare Medicare Advantage plans only)
• Enroll by phone at 1-866-311-6521 for a UCare Medicare Advantage plan
• Enroll with the help of a local health insurance broker

Medicare created Special Election Periods (SEP) for specific situations that may allow you to change plans. Some of the most common situations that allow you to qualify for a SEP include:

• Leaving or losing coverage through an employer or union (including COBRA)
• Making a permanent move where new plan options are available
• Becoming eligible, or losing eligibility, for Medical Assistance
• You receive Extra Help for Medicare Part D

Certain time frames and limitations apply to each of the special election periods.

Medicare has limits to when and how often you can change your Medicare health plan. These specific "election periods" determine when you can enroll in, or disenroll from, a Medicare Advantage plan. These periods include:

• Initial Coverage Election Period (ICEP): When you first become eligible for Medicare
• Annual Election Period (AEP): Every year between Oct. 15 and Dec. 7 you can make changes to your plan choices for the following year
• Special Election Periods (SEP): For specific situations that occur throughout the year that may allow you to change plans
• Medicare Advantage Open Enrollment Period (MA-OEP): Every year between Jan. 1 and March 31, Medicare Advantage members can make a one-time change and switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and go back to Original Medicare only

You can first enroll in Medicare through Social Security about three months before your 65^th birthday month by going online at ssa.gov, by phone at 1-800-772-1213 or in person at a Social Security office.

Once UCare receives your Medicare Advantage application, your enrollment information is sent to Medicare. Upon approval, a letter is mailed to you confirming your UCare coverage. You can expect to receive your ID card approximately a week after you get your confirmation letter or you can download it in your online member account.

UCare will try to reach you by phone to complete your enrollment. If unable to reach you by phone, we will mail a letter to you asking for the missing information.

If you are already receiving Social Security benefits, you’ll be enrolled in Medicare automatically. Your Medicare card will arrive about three months before the month you turn 65.

You can reach our Customer Service team by calling the number on the back of your ID card. Visit the UCare customer service page to find our phone numbers. 

UCare may require your doctor to send us information about why a service or prescription is medically necessary to determine if it will be covered. This process is called prior authorization. Members are not responsible for getting prior authorization; it is your doctor's responsibility.

• For prescription authorizations, your doctor's office should contact Navitus Health Solutions, UCare's pharmacy benefit manager (PBM)
• For other services requiring prior authorization, your doctor's office can contact UCare's Provider Assistance Center

When you enroll in a UCare Medicare Advantage plan, chances are you can keep your doctor, since most Minnesota providers are in our network. We also have plans where you get all your care within one care system, like Essentia Health.

With UCare Medicare Advantage plans, you may see any specialist in the network without a referral. Medicare Supplement plans have no network, so you may use any Medicare provider.

A UCare Medicare Advantage plan gives you access to a large statewide network of providers. Plus, you have in-network coverage at participating providers nationwide. Learn more about our coverage when traveling or see your Summary of Benefits for more information.

You can see any specialist as long as they accept Medicare, though out-of-network costs may apply. See your Summary of Benefits for details.

You can visit an out-of-network licensed dentist, but you may pay more since your plan offers the most value for in-network dental care. When seeing an out-of-network dentist, UCare Medicare Plan (HMO-POS) members are responsible for paying the cost sharing and any difference between the fee schedule and the actual billed charge, along with submitting bills to UCare. UCare Your Choice Plan (PPO) members receive a combined flexible benefit allowance that includes dental with no network restrictions.

You can search our network a few different ways:

• Use the Search Network tool to get the most up-to-date information. You can search for a doctor, pharmacy, dentist or chiropractor.
• Get help from our Customer Service team to find providers in your plan network
• Check your provider directory. Call Customer Service and we'll mail you a directory.

UCare Medicare Advantage Plans (also called Medicare Part C) contract with the federal government to administer Medicare Part A and Part B. They cover everything that Original Medicare covers, provide additional benefits like Part D prescription drug coverage. Because you get all your health coverage in one plan, you won’t have to deal with Medicare deductibles and coinsurances. You’ll be responsible only for cost-sharing (copays, coinsurance) with our plans.

With a Medicare supplement (also called “Medigap”) plan, the bills you receive from your providers are first sent to Medicare, then to your plan. Medicare supplement plans are medical-only coverage and generally cover the costs that Original Medicare only does not cover, such as the Part A deductible, copays and coinsurance. Medicare Supplement plans do not include Part D prescription drug coverage or "extras" such as dental. To learn more about UCare Medicare Supplement plans visit this page.

All UCare Medicare Advantage plans include dental benefits. Some plans give you the option to add more dental coverage. Learn more about UCare Medicare Advantage dental coverage or see your Summary of Benefits.

No. If you are satisfied with your current UCare Medicare Advantage plan, you do not have to do anything during the Medicare Annual Election Period. Your coverage will continue. If you choose to change plans, you can do so Oct. 15 – Dec. 7 for coverage beginning Jan. 1.

Yes, with a UCare Medicare Advantage plan the three-day inpatient hospital stay requirement for skilled nursing facilities is waived. That means your skilled nursing benefit can be used right away.

Yes, we offer meetings throughout Minnesota and Northwest Wisconsin both online and in the community. Join us for an upcoming Medicare meeting.

You can use One Pass^® fitness benefits at local gyms and when you travel. The network includes gyms and fitness locations nationwide.

No, you do not have to inform UCare that you are traveling. You also have emergency coverage worldwide.

Yes, you'll have access to many out-of-state Medicare providers at in-network coverage with a UCare Medicare Advantage plan. Specific coverage varies by plan. Emergency care is always covered worldwide at any provider, with a copay. See your Summary of Benefits for details.

UCare Medicare Advantage plans include coverage for dental, chiropractic, hearing and vision services. For more specific details on how these services are covered, please refer to your Summary of Benefits for cost sharing or contact Customer Service for detailed information.

Yes, once you have reached $2,000 in annual out-of-pocket costs on Medicare Part D prescription drugs (excluding UCare's cost), you pay $0. Please see your Summary of Benefits for details.

No, the Medicare Part D benefit is a separate benefit that has its own coverage limits. Therefore, it does not apply to your medical out-of-pocket maximum.

Medicare Part B drugs that are administered by a health care professional in the form of a shot or infusion, such as chemotherapy, do count toward your medical out-of-pocket maximum.

The list of covered drugs (called a formulary) differs by plan. The UCare Your Choice formulary is designed to offer value and the UCare Medicare Plans formulary offers our broadest prescription drug coverage. Use the online search tool to find out what's covered and how much it will cost under each plan. Or call 1-866-311-6521 to have a printed list of covered drugs mailed to you.

To find in-network pharmacies, search our online directory or call 1-877-671-1061 to request a Provider and Pharmacy Directory. More than 63,000 pharmacies are in our plan network, including: Coborn's, Costco, Cub, CVS/Target, Fairview Pharmacy, Hy-Vee Pharmacy, Sam's Club/Walmart, Thrifty White, Walgreens and more.

Medicare Part D is a voluntary outpatient prescription drug program available to anyone who is enrolled in Medicare Part A or Part B. It is often included in a Medicare Advantage plan and helps Medicare beneficiaries pay for their prescription drugs. As you spend money on your covered drugs, you progress through the coverage phases until the new calendar year. Starting in 2025, the three phases of coverage include:

• Deductible phase: You pay the full negotiated price for your covered prescriptions until you meet your Part D annual deductible
• Initial coverage phase: During this phase, your plan pays some of the cost and you pay coinsurance or a copay based on the medication tier. You stay in this phase until you reach the $2,000 out-of-pocket maximum (excludes UCare’s cost) for covered drugs.
• Catastrophic coverage phase: During this phase, you pay nothing in copays or coinsurance for the cost of your covered drugs for the remainder of the year

Not all plans have the same deductible or copays for drug tiers. See your Summary of Benefits for specifics.

UCare Medicare Advantage plan members have several options for lowering prescription costs:

• Drug tier changes: If your medication falls in a Tier 2 or Tier 4, it may be eligible to be reviewed for a tiering exception. If approved, the cost of your drug would be lowered to the tier below, in turn lowering your copay. To start the tiering exception process, your provider can contact Navitus Health Solutions. You can also start by calling our plan or by accessing the coverage decision process through our website.
• Financial assistance: You may also apply and qualify for Low Income Cost Sharing (LICS). To find out if you qualify, contact Medicare at 1-800-633-4227 or visit the Medicare website for information.
• Patient assistance programs: Certain drugs have patient assistance programs that can help pay for a particular medication. To find out if your drug qualifies, contact UCare Customer Service.
• Generic prescriptions: If you are taking a brand name drug, contact your doctor to see if there is a generic alternative for the medication. Keep in mind not all brand name medications have generic substitutes.
• Starting in 2025, you can spread out-of-pocket Part D costs throughout the year through the Medicare Prescription Payment Plan. This new program allows you to pay your out-of-pocket prescription drug costs monthly instead of paying at the pharmacy and is especially helpful if you have high out-of-pocket drug costs earlier in the year.

You can pay your premium in one of the following ways:

• Using Automatic Payment/Electronic Funds Transfer (EFT) from a checking or savings account
• By mail: You will receive your monthly billing statement around the 20^th of each month for the next coverage month
• Social Security or Railroad Retirement Board withdrawal
• Online at member.ucare.org

Medicare Part A usually has no premium because it was paid for by payroll tax deductions during your (or your spouse’s) working years. Medicare Part B does have a premium. Premiums for the following year are usually announced in late October or early November.

It is a Medicare requirement that we send annual updates and required information to each member enrolled in our Medicare plans. This ensures you and your spouse stay informed of any updates or changes with your health care coverage.

To help keep our members’ information as secure as possible, we require each individual member to register for a secure online member account separately. This ensures your private health information and claims are only accessible by you, and helps minimize the risk of error when entering your information.