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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 $38.00. 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 will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will 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 Medicare Part D covered drugs.
Additional Benefits
The UCare Essentials Rx (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $400 copay, while outpatient services have copays ranging from $275 to $300. Emergency services have a $100 copay, and primary care visits are covered with no copay. Preventive services are generally covered with no copay, and the plan includes coverage for hearing and vision services with copays. Dental services are covered up to a $2,000 annual maximum. The plan also offers coverage for home health with no copay, but does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered by the UCare Essentials Rx (HMO-POS) plan, with a copay of $400 per admission or stay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the UCare Essentials Rx (HMO-POS) plan, including all outpatient hospital services, and observation services with a $300 copay, and ambulatory surgical center services with a $275 copay. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered. There is no copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by UCare Essentials Rx (HMO-POS). Ground and air ambulance services have a $250 copay, and there is no coinsurance. 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 under the UCare Essentials Rx (HMO-POS) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $45 copay, but both have no coinsurance, and Worldwide Emergency Services include a $100 copay for Worldwide Emergency and Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation.
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, Physician Specialist Services with a $45 copay, Physical Therapy and Speech-Language Pathology Services with a $40 copay, and Other Health Care Professional services with a copay between $0 and $45. The plan's Mental Health and Psychiatric Services do not cover individual or group sessions. The plan's Additional Telehealth Benefits have a coinsurance between 10% and 20% 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. The plan also covers annual physical exams, additional preventive services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, counseling services, kidney disease education services, and other preventive services. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, home and bathroom safety devices and modifications, and in-home support services are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, as well as routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$45. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are also covered, with a combined maximum plan benefit of $150 per year for eyewear.
Dental Services See details
The UCare Essentials Rx (HMO-POS) plan covers dental services with a maximum plan benefit of $2,000 per year. The plan covers oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, but only covers 1 oral exam, 1 dental x-ray, and 1 prophylaxis (cleaning) per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the UCare Essentials Rx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits for UCare Essentials Rx (HMO-POS) include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Medicare-covered supplies and therapeutic shoes/inserts; Durable Medical Equipment for use outside the home is not covered.
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 UCare Essentials Rx (HMO-POS) with no copay and no coinsurance. However, 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. While the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by UCare Essentials Rx (HMO-POS), with no copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The UCare Essentials Rx (HMO-POS) plan covers some Other Services, including Over-the-Counter (OTC) Items, with a maximum benefit of $75 every six months. 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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