Be sure to read this important information before you enroll.

Find the Plan That’s Right for You

We offer four levels of coverage to fit a variety of needs. Take a moment to compare the different plans below and learn what more than 88,000 members across Minnesota and western Wisconsin already know. UCare for Seniors gives you more from your Medicare plan.

	Classic	Value Plus	Standard D	Value
2012 Monthly premium +	Minnesota: $137 Wisconsin: $159	Minnesota: $84 Wisconsin: $89	Minnesota: $54 Wisconsin: $67	Minnesota: $43 Wisconsin: $61
Primary care doctor office visits	$0 co-pay.	$0 co-pay.	$0 co-pay.	$0 co-pay.
Specialist office visits	$15 co-pay per visit.	$30 co-pay per visit.	$35 co-pay per visit.	$30 co-pay per visit.
Inpatient hospital care	100% after $150, co-pay per inpatient admission.	100% after $300, co-pay per inpatient admission.	100% after $500, co-pay per inpatient admission.	100% after $300, co-pay per inpatient admission.
Worldwide emergency care	$65 co-pay; co-pay is waived if admitted to the hospital within 24 hours for the same condition.	$65 co-pay; co-pay is waived if admitted to the hospital within 24 hours for the same condition.	$65 co-pay; co-pay is waived if admitted to the hospital within 24 hours for the same condition.	$65 co-pay; co-pay is waived if admitted to the hospital within 24 hours for the same condition.
Prescription drug coverage	Included.	Included.	Included.	N/A
Dental coverage	Included.	N/A	N/A	N/A
Vision Coverage	$0 co-pay for annual routine eye exams. $15 co-pay for diagnostic eye exam. $75 annual plan benefit maximum for eyeglasses or contacts at any provider.	$0 co-pay for annual routine eye exams. $30 co-pay for diagnostic eye exam.	$0 co-pay for annual routine eye exams. $35 co-pay for diagnostic eye exam.	$0 co-pay for annual routine eye exams. $30 co-pay for diagnostic eye exam.
Hearing aid benefit	$500 plan benefit maximum every 36 months.	N/A	N/A	N/A

For more plan comparison information, check out A Guide to Comparing Your Options.

Minnesota (PDF)
Wisconsin (PDF)

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.

Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2013.

^†You must continue to pay your Medicare Part B premium if not paid for under Medicaid or by another third-party.

December 2011

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