UCare for Seniors Flashcards

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.