UCare for Seniors Standard (HMO-POS)

Medicare Advantage Plan for Minnesota

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderUcare
Plan IDH2459-24-0
CMS Rating1
Plan TypeHMO-POS
Annual Deductible$405.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$4,500 In-network $10,000 Out-of-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$9.50
Monthly Health Plan Premium
$63.50

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$500 for days 1 through 3
$0 for days 4 through 90
Out-of-Network:
20% per stay
Outpatient hospital coverage
In-Network:
$300 or 10% per visit
Out-of-Network:
20% per visit
Doctor visits
Primary:
In-Network:
$0 copay
Out-of-Network:
20% per visit
Specialist:
In-Network:
$40 per visit
Out-of-Network:
20% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$40 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
10%
Out-of-Network:
20%
Lab services:
In-Network:
$0 copay
Out-of-Network:
$0 copay
Diagnostic radiology services (e.g., MRI):
In-Network:
10%
Out-of-Network:
20%
Outpatient x-rays:
In-Network:
10%
Out-of-Network:
20%
Mental health services
In-Network:
$500 for days 1 through 3
$0 for days 4 through 90
Out-of-Network:
20% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
20%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
20%
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
20%
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
20%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network:
20% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$40
Out-of-Network:
20%
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
20%
Ambulance
In-Network:
$200
Out-of-Network:
$200
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$40
Out-of-Network:
20%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
20% per item
Diabetes supplies:
In-Network:
20% per item
Out-of-Network:
20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
20%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
20%

Coverage Area for UCare for Seniors Standard (HMO-POS)

StateMinnesota
CountyRamsey

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds25% coinsuranceNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered25% coinsuranceNot offered
Tier 2: Non-Preferred Generic
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept UCare for Seniors Standard (HMO-POS) for Minnesota

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SMITH, GEORGE
UFP PHALEN VILLAGE CLINIC
SAINT PAUL, MN 55106
CERMAK, PETER
UFP PHALEN VILLAGE CLINIC
SAINT PAUL, MN 55106
CLARK, KIRBY
UFP PHALEN VILLAGE CLINIC
SAINT PAUL, MN 55106
JANZEN, GLENDA
1165 ARCADE ST
SAINT PAUL, MN 55106
YANG, PETER
1504 WHITE BEAR AVE NORTH
SAINT PAUL, MN 55106
ROBERTS, WILLIAM
UFP PHALEN VILLAGE CLINIC
SAINT PAUL, MN 55106
HATLESTAD, PRESTON
1414 MARYLAND AVE E
SAINT PAUL, MN 55106
GAPINSKI, LEAH
1035 ORANGE AVE E
ST. PAUL, MN 55106
BARSANTI, JOHN
911 MARYLAND AVE E
SAINT PAUL, MN 55106
CURRENT, DAVID
UFP PHALEN VILLAGE CLINIC
SAINT PAUL, MN 55106
MYLREA, JAMES
166 4TH ST E
SAINT PAUL, MN 55101
MUNDY, MATTHEW
640 JACKSON ST
SAINT PAUL, MN 55101
STELLPFLUG, SAMUEL
640 JACKSON ST
SAINT PAUL, MN 55101
KIESLING, SARAH
200 UNIVERSITY AVE E
SAINT PAUL, MN 55101
CHAUDHARY, NADEEM
640 JACKSON ST
SAINT PAUL, MN 55101
PEDERSON, PATRICK
640 JACKSON ST
SAINT PAUL, MN 55101
ZHAO, ZHONG
640 JACKSON ST
SAINT PAUL, MN 55101
OAKMAN, SCOTT
640 JACKSON ST - MAIL STOP 11302C
ST. PAUL, MN 55101
GRAVEN, KRISTA
401 PHALEN BLVD
ST PAUL, MN 55101
REEVE, ELIZABETH
640 JACKSON ST
ST. PAUL, MN 55101
TURNER, MATTHEW
640 JACKSON ST
SAINT PAUL, MN 55101
HARRIS, SUZANNE
640 JACKSON ST
ST PAUL, MN 55101
ZANDER, JANET
640 JACKSON ST
SAINT PAUL, MN 55101
RIZVI, MOHAMMAD
640 JACKSON ST - MS 11102M
ST. PAUL, MN 55101
KALLIAINEN, LOREE
640 JACKSON ST
SAINT PAUL, MN 55101
Details
GEORGE SMITH, MD
Phone Number
(651) 772-3461
Office Locations
UFP PHALEN VILLAGE CLINIC
SAINT PAUL, MN 55106
UFP PHALEN VILLAGE CLINIC SAINT PAUL MN, 55106

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