UCare's MSHO 2025 Part D prescription drug coverage
What is Medicare Part D prescription drug coverage?
Medicare Part D helps cover costs for your outpatient prescription drugs and some vaccines that aren't covered under Medicare Part A or Part B. Medicare Part D drug plans offer a formulary (list of covered drugs) with set copays. As a member of UCare's Minnesota Senior Health Options (MSHO) (HMO D-SNP), you automatically receive Medicare Part D prescription drug coverage.
Paying for your prescriptions
Beginning January 1, 2025, UCare's MSHO members will no longer have copays for covered prescription drugs.
Because you have Medicaid (Medical Assistance), you qualify for Extra Help, also known as the Part D Low-Income Subsidy (LIS). Extra Help is a Medicare program for people with limited income and resources to pay Medicare Part D drug coverage premiums, deductibles, coinsurance and other costs. Coinsurance may vary based on the level of Extra Help received. The amount of Extra Help you get will determine the cost of your monthly Part B premium. You may also be automatically enrolled in Extra Help. For more information, call:
- 1-800-MEDICARE (1-800-633-4227)
(TTY 1-877-486-2048), 24 hours a day, seven days a week - Your county or Tribal office
- The Social Security Administration at 1-800-772-1213
(TTY 1-800-325-0778), 7 am – 7 pm, Monday – Friday
You can also find information on the Medicare and Social Security Administration websites.
Important documents
- Prescription Drug Claim Form (PDF)
- Request for Medicare Prescription Drug Coverage Determination Form (PDF)
- Request for Redetermination of Medicare Prescription Drug Denial Form (PDF) — coming soon
- Prescription Drug Transition Policy (PDF) — coming soon
Resources
Medication Therapy Management (MTM) — while not a part of the Part D prescription drug benefit, MTM is a pharmacy program sponsored by UCare available to all Medicare-eligible members who meet program criteria.
Best Available Evidence policy — the Centers for Medicare & Medicaid Services (CMS) created this policy to address incorrect LIS benefit information and ensure Medicare beneficiaries aren't overcharged for prescriptions. Learn more and download necessary forms.
Coverage determinations, appeals and grievances — find out how to make a complaint if you have concerns about your Part D coverage.
Filling your prescriptions
Generally, you must get your prescription drugs from pharmacies in UCare’s network. Find if your pharmacy is in UCare's network, using the pharmacy search tool.
Check if your prescription drugs are covered using the drug search tool in the formulary. You can also use the formulary to review prior authorization and formulary exception criteria.
Mail order pharmacy
Save time with free home delivery from Costco Mail Order Pharmacy. 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 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 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 business days from the time the mail order pharmacy receives the order.