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EssentiaCare Secure (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for EssentiaCare Secure (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on EssentiaCare Secure (PPO) in 2025, please refer to our full plan details page.
EssentiaCare Secure (PPO) is a PPO plan offered by UCare Minnesota available for enrollment in 2025 to people living in Northern MN and 3 County WI. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that EssentiaCare Secure (PPO) 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 EssentiaCare Secure (PPO).
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 EssentiaCare Secure (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.00. 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 $95.00 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 combined Maximum Out-Of-Pocket cost of $5500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 EssentiaCare Secure (PPO) plan has a $95 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For the initial coverage phase, you will pay $7 for preferred generic drugs, $47 for standard generic drugs, and $100 for preferred brand drugs. Non-preferred drugs have a 29% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The EssentiaCare Secure (PPO) plan offers a variety of benefits, including inpatient hospital stays with a $300 copay for the first 5 days, and no copay thereafter. Outpatient services have a $350 copay, while emergency services cost $100. Primary care visits have a $20-$45 copay, and many preventive services are covered. The plan covers hearing exams with a $45 copay, and vision services with a $0-$45 copay for routine eye exams, and provides a $2000 annual maximum for dental services. Additionally, the plan includes home health services with no copay, and offers an OTC benefit up to $50 per month.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $300 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered, with a $300 copay for days 1-5 and no copay for days 6-90, while Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services, are covered with a $350 copay. Outpatient Substance Abuse Services are not covered, and Outpatient Blood Services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the EssentiaCare Secure (PPO) plan. The specific costs associated with this benefit are not described in the provided information.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the EssentiaCare Secure (PPO) plan. Ground and Air Ambulance Services have a copay of $375, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the EssentiaCare Secure (PPO) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage and Urgent Coverage have a $100 copay, and Worldwide Emergency Transportation has a $375 copay.
Primary Care See details
The EssentiaCare Secure (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $45 copay, other health care professional services with a copay ranging from $0 to $45, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $0-$45 copay and 10%-20% coinsurance, and opioid treatment program services. However, routine chiropractic care, individual and group mental health specialty sessions, podiatry services, individual and group psychiatric sessions, are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and additional preventive services, are covered. Additional Sessions of Smoking and Tobacco Cessation Counseling, a Fitness Benefit (Memory Fitness), Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services with the EssentiaCare Secure (PPO) plan include hearing exams with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered, but prescription hearing aids and OTC hearing aids are not covered. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered three times per year.
Vision Services See details
EssentiaCare Secure (PPO) covers vision services, including routine eye exams with a copay of $0-$45. Eyewear is covered, with a combined maximum benefit of $100 per year for both in-network and out-of-network services, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay or coinsurance.
Dental Services See details
EssentiaCare Secure (PPO) covers a range of dental services, including oral exams, dental X-rays, prophylaxis (cleaning), and fluoride treatments. This plan offers a maximum benefit of $2000 per year for both in-network and out-of-network services, and some services like restorative services, endodontics, implant services, and others are offered as optional, supplemental benefits. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the EssentiaCare Secure (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by the EssentiaCare Secure (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. 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 EssentiaCare Secure (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the EssentiaCare Secure (PPO) plan, but the specific sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan states that there is a copay for some Cardiac and Pulmonary Rehabilitation Services, but does not provide the exact amount.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the EssentiaCare Secure (PPO) plan, with no copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The EssentiaCare Secure (PPO) plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage of $50.00 every month, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, meal benefits, and other listed services are not covered.
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