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*By completing an enrollment form online, you are requesting enrollment in UCare for Seniors. You will receive notice in the mail acknowledging receipt of your completed enrollment request or requesting additional information.

You must read this information before you enroll in UCare for Seniors

• UCare Minnesota and UCare Wisconsin, Inc. are Medicare Advantage organizations with Medicare contracts. These contracts are renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed.
• Members must use plan providers for routine care except for emergency care, out-of-area renal dialysis/urgent care, (and in-area urgent care when the UCare for Seniors network is temporarily unavailable), and Point-of-Service benefits. If you obtain care from out-of-network providers neither Medicare or UCare for Seniors will be responsible for the costs.
• Members may enroll in a plan only during specific times of the year. For more information contact UCare at 1-877-598-6574 toll free (TTY 1-800-688-2534 toll free), 8 a.m. to 8 p.m., seven days a week.
• You must continue to pay your Medicare Part B premium.
• You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:
• 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should call 1-877-486-2048 (24 hours a day/7 days a week).
• The Social Security Administration or 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 1-800-325-0778; or
• Your state Medicaid Office.
• In general, Part D benefits are only available at contracted retail, mail order, LTC, I/T/U, and Home Infusion pharmacies (under emergency circumstances, benefits may be obtained out-of network).
• Contact UCare for network pharmacy and mail order information at 1-877-523-1518 (TTY 1-800-688-2534) or write to P.O. Box 52, Minneapolis, MN 55440.
• If you are already enrolled in a Medicare Advantage Plan with Medicare prescription drug coverage, you must receive your prescription drug coverage through that plan.
• Premiums listed are for both medical services and prescription drug benefits.
• The Medicare program rates how well plans perform in different categories (for example, detecting and preventing illness, ratings from patients and customer service). If you have access to the web, you may use the web tool on www.medicare.gov and select "Compare Medicare Prescription Drugs Plans" or "Compare Health Plans and Medigap Policies in Your Area" to compare the plan ratings for Medicare plans in your area. You can also call us directly at 612-676-3500 or 1-877-523-1518 toll free to obtain a copy of the plan ratings for this plan. TTY users call 612-676-6810 or toll free at 1-800-688-2534.
• For full information on UCare for Seniors benefits, call UCare at 1-877-598-6574 toll free (TTY 1-800-688-2534 toll free).
• This information is available in alternative formats. For more information, call UCare's Customer Services Department at 612-676-6840 or 1-877-447-4385 toll free. If you are hearing impaired, please call our TTY Line at 612-676-6810 or 1-800-688-2534 toll free. We can be reached 8 a.m. to 8 p.m., seven days a week.