Questions and Answers
What does UCare for Seniors provide?
How does UCare for Seniors work as a Coordinated Care Plan?
UCare contracts with the federal government to administer Medicare benefits for members.
Who does UCare contract with to administer Part A and Part B for UCare for Seniors members?
The Federal Government
Who is UCare for Seniors available to?
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Is there health screening for pre-existing conditions for UCare for Seniors?
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How many counties in MN and WI is UCare for Seniors Value Plan and Essentials Rx plans available?
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In how many counties is UCare for Seniors Value Plus and Classic available?
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Do UCare for Seniors products provide all the benefits as Original Medicare?
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Does UCare for Seniors only cover individuals?
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What type of plan is UCare for Seniors?
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What does the Point of Service feature allow UCare for Seniors members to do?
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Are emergency services included in UCare for Seniors?
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Name all four of the UCare for Seniors products.
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Do UCare for Seniors members pay a premium for coverage?
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What is extra help for Part D?
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When was UCare for Seniors first offered?
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How many members are enrolled in UCare for Seniors?
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What are the target populations for UCare for Seniors?
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What does Medicaid provide?
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What does the acronym CMS stand for?
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What is HEDIS?
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What does MA-PD stand for?
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What is the Medical Loss Ratio?
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What is a Copay?
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What is PBM?
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What are Election Periods?
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Study Notes
UCare for Seniors Overview
- A Coordinated Care Medicare Advantage Plan that provides Medicare Part A and Part B benefits.
- Enrolled members receive Medicare benefits through UCare instead of Original Medicare.
Enrollment and Eligibility
- Available to all eligible Medicare beneficiaries, with no income or asset restrictions.
- No health screenings for pre-existing conditions, except for end-stage renal disease.
- Coverage is offered in all 87 counties in Minnesota and 26 counties in Wisconsin.
UCare for Seniors Plans
- Offers four products: Value, Essentials Rx, Value Plus, and Classic.
- Not all products provide the same benefits; for example, Value does not include Medicare Part D.
- Essentials Rx includes limited dental benefits and prescription drug coverage.
- Value Plus and Classic provide comprehensive medical coverage and Part D benefits.
Coverage and Benefits
- UCare for Seniors products match Original Medicare benefits and add supplemental benefits like emergency coverage and preventive services without copays.
- Plans are available to both individuals and employer group retirees, excluding active employees.
Network and Care Features
- Functions as a Health Maintenance Organization with a Point-of-Service contract, providing access to a network of doctors.
- Emergency and urgent care services covered worldwide at in-network cost share levels.
- The Point-of-Service feature permits members to seek care from non-contracted providers at higher costs.
Cost and Financial Assistance
- Members pay premiums that vary by product, with potential reductions for those who qualify for Extra Help for Part D.
- Extra Help assists low-income individuals with Part D premium and cost share.
Historical Context and Membership
- UCare for Seniors was established in 1998 and now serves over 100,000 members, generating approximately 42% of company revenue.
- Target populations include baby boomers and current Medicare beneficiaries, as well as those eligible due to disability.
Regulatory and Administrative Details
- Contracts with the federal government and CMS to administer Medicare Advantage and Part D coverage.
- UCare adheres to requirements set by regulatory bodies, including annual bid proposals for plan benefits.
Performance and Quality Metrics
- Participates in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to assess member experiences.
- HEDIS metrics evaluate care effectiveness across various dimensions, including access, utilization, and health plan stability.
Medicare Framework
- Medicare consists of Parts A (hospital insurance), B (medical insurance), C (Medicare Advantage), and D (prescription drug coverage).
- Medicare Advantage Organizations (MAOs) provide enhanced benefits compared to Original Medicare, often covering additional services.
Key Terminology
- Coinsurance: Percentage paid for services after deductibles.
- Copay: Fixed amount paid for specific services.
- Cost share: Total member's financial responsibility (copay, coinsurance, deductible).
- Dual eligible: Individuals qualifying for both Medicare and Medicaid.
- Stand Alone PDP: Specific drug plans covering only outpatient prescription medications.
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Description
Test your knowledge about UCare for Seniors with these flashcards. Learn how this coordinated care plan works, including its relationship with Medicare. Perfect for those looking to understand senior healthcare options better.
