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UCare Standard (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for UCare Standard (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on UCare Standard (HMO-POS) in 2025, please refer to our full plan details page.
UCare Standard (HMO-POS) is a HMO-POS plan offered by UCare Minnesota available for enrollment in 2025 to people living in Southern Minnesota. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that UCare Standard (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 Standard (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 Standard (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 $480.00 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 $6000.00 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 Standard (HMO-POS) plan has a $480 deductible for prescription drugs. After the deductible is met, you'll pay a copay for your prescriptions. For example, you'll pay a $10 copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic drugs, the copay is $47.00, and for preferred brand drugs, the copay is $100. Non-preferred drugs have a 27% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The UCare Standard (HMO-POS) plan offers a wide range of benefits. This plan covers inpatient hospital stays with a $500 copay for the first 3 days, then no copay for days 4-90. Outpatient services have a $300 copay, and emergency services have a $100 copay. This plan provides coverage for primary care, including chiropractic, occupational, and specialist services, with copays ranging from $20 to $40. Preventive services, such as annual physical exams, have no copay. The plan also includes hearing, vision, and dental benefits, with specific copays and annual maximums.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 3 days, there is a $500 copay, and days 4-90 have no copay. Additional Days for Inpatient Hospital-Acute are covered. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, have a $300 copay, while Ambulatory Surgical Center (ASC) Services have a $275 copay. Outpatient Substance Abuse Services are not covered, but Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered. This plan provides coverage for partial hospitalization, but does not specify any cost information such as copay or coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the UCare Standard (HMO-POS) plan. Ground and air ambulance services have a copay of $375, 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. Emergency Services have a $100 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $100 copay, while Worldwide Emergency Transportation has a $375 copay.
Primary Care See details
The UCare Standard (HMO-POS) plan covers primary care services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, and physical therapy and speech-language pathology services with a $40 copay. Additionally, the plan covers additional telehealth benefits with a 10-20% coinsurance and a $0-$40 copay, and opioid treatment program services. Routine chiropractic care, individual and group sessions for mental health and psychiatric services, and podiatry services are not covered.
Preventive Services See details
The UCare Standard (HMO-POS) plan covers preventive services, including annual physical exams, with no copay. Additional services like Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered. The plan also covers support for caregivers, additional sessions of smoking and tobacco cessation counseling, fitness benefits (memory fitness, up to $30 per month), counseling services (both individual and group sessions), Kidney Disease Education Services, and other preventive services with no copay.
Hearing Services See details
Hearing Services are covered, including routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $699 and $999, but prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$40, and eyewear with a combined maximum benefit of $100 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The UCare Standard (HMO-POS) plan offers a dental benefit with a $2,000 annual maximum. Covered services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, with limitations on the number of visits per year. Orthodontic services are also covered, with a maximum benefit under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the UCare Standard (HMO-POS) plan. There is a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered by the UCare Standard (HMO-POS) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. For DME, there is a 20% coinsurance, with no copay; for Prosthetics/Medical Supplies, the coinsurance is 20%; and for Diabetic Equipment, the coinsurance is 20% for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the UCare Standard (HMO-POS) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 10%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the UCare Standard (HMO-POS) plan 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 Standard (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 under the UCare Standard (HMO-POS) plan. You will pay no copay for days 1-20, and a $214 copay for days 21-100; there is no coinsurance.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, including nicotine replacement therapy and naloxone, with a maximum benefit of $75 every six months. Acupuncture, Meal Benefit, 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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