2025 UCare Medicare Plan Documents and Forms
UCare Medicare
Formulary (list of covered drugs)
Provider and Pharmacy Directory (PDF)
Service area map (PDF)
UCare Dental Overview (PDF)
Plan Rating Information (PDF)
Plan Rating Information - Spanish (PDF)
Member Release of Information Form (PDF)
Statement of Representative Form (PDF)
Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Automatic Payment Form (PDF)
Online Automatic Payment Form
Claim Reimbursement Form (PDF)
Advance Directives (PDF)
Enrollment Forms
Fillable PDFs
2025 Medicare Enrollment Form - Metro (PDF)
2025 Medicare Enrollment Form - North (PDF)
2025 Medicare Enrollment Form - South (PDF)
2025 Medicare Enrollment Form - Metro - Spanish (PDF)
2025 Medicare Enrollment Form - South - Spanish (PDF)
2025 Medicare Enrollment Form - North - Spanish (PDF)
2025 UCare Medicare Enrollment Change Form (PDF)
Online Forms
2025 Dental Enrollment Form
2025 Medicare Enrollment Form - Metro
2025 Medicare Enrollment Form - North
2025 Medicare Enrollment Form - South
UCare Medicare Advantage Plans Overview (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Summary of Benefits - North - Spanish (PDF) - coming soon
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)
UCare Medicare Advantage Plans Overview (PDF)
Metro
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
North
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - North - Spanish (PDF) - coming soon
UCare Medicare Advantage Plans Overview (PDF)
Metro
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
North
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - North - Spanish (PDF) - coming soon
Plan Comparison Chart - North (PDF)
South
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - South (PDF)
Summary of Benefits - South - Spanish (PDF)
UCare Medicare Advantage Plans Overview (PDF)
Metro
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
North
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - North (PDF)
Plan Comparison Chart - North (PDF)
South
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
UCare Medicare Advantage Plans Overview (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - South (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Summary of Benefits - North - Spanish (PDF) - coming soon
Summary of Benefits - South - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)
Plan Comparison Chart - South (PDF)
Part B Medical Injectable Drug Authorization List (PDF) updated 10/11/2024
UCare Medicare Advantage Plans Overview (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - South (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Summary of Benefits - North - Spanish (PDF) - coming soon
Summary of Benefits - South - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)
Plan Comparison Chart - South (PDF)
Part B Medical Injectable Drug Authorization List (PDF) updated 10/11/2024