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UCare Essentials Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UCare Essentials Rx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UCare Essentials Rx (HMO-POS) in 2025, please refer to our full plan details page.
UCare Essentials Rx (HMO-POS) is a HMO-POS plan offered by UCare Minnesota available for enrollment in 2025 to people living in 46 Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UCare Essentials Rx (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about UCare Essentials Rx (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For UCare Essentials Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $295.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7500.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $3800.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7500.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The UCare Essentials Rx (HMO-POS) plan has a $295 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay a $10 copay for preferred generic drugs at a standard pharmacy and 29% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you may have a reduced premium.
Additional Benefits
The UCare Essentials Rx (HMO-POS) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a $400 copay, while outpatient services have a $300 copay. Emergency services have a $100 copay, and primary care visits have no copay. This plan also covers preventive services with no copay and offers vision benefits, including eye exams with a copay between $0-$45, and eyewear with a combined maximum benefit of $150 per year. Dental services are covered up to $2,000 per year. Additionally, this plan offers home health services with no copay, and skilled nursing facility services with no copay for the first 20 days, and a $214 copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with a $400 copay per admission or stay. Additional days for Inpatient Hospital-Acute are also covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, along with Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with a $300 copay. Ambulatory Surgical Center (ASC) Services have a $275 copay, while outpatient substance abuse services (individual and group sessions) are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by UCare Essentials Rx (HMO-POS).
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the UCare Essentials Rx (HMO-POS) plan. Ground and Air Ambulance Services each have a $250 copay, and there is no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the UCare Essentials Rx (HMO-POS) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $100 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation; all services have no coinsurance.
Primary Care See details
The UCare Essentials Rx (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $45 copay. Additional telehealth benefits have a 10-20% coinsurance and a copay between $0 and $45.
Preventive Services See details
The UCare Essentials Rx (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, support for caregivers, and additional sessions for smoking cessation. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services.
Hearing Services See details
Hearing Services include routine hearing exams with a $45 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $699 and $999, but prescription hearing aids - inner ear, outer ear, and over the ear, are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The UCare Essentials Rx (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$45, eyewear with a combined maximum benefit of $150 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay and no coinsurance. You are eligible for one routine eye exam per year.
Dental Services See details
The UCare Essentials Rx (HMO-POS) plan covers dental services with a maximum benefit of $2,000 per year. Specific services like oral exams, dental x-rays, cleaning, and fluoride treatments are covered, but coverage for services such as maxillofacial prosthetics and orthodontics is not included.
Home Infusion bundled Services See details
Home Infusion bundled Services include coverage for Medicare Part B Insulin Drugs with a $35 copay. Coverage is also included for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UCare Essentials Rx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the UCare Essentials Rx (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment, including Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, has a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UCare Essentials Rx (HMO-POS) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 10%, and Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the UCare Essentials Rx (HMO-POS) plan, with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the UCare Essentials Rx (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the UCare Essentials Rx (HMO-POS) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services for UCare Essentials Rx (HMO-POS) includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $75 every six months. However, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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