2025 UCare Medicare Plan Documents and Forms
UCare Medicare
Formulary (list of covered drugs)
Provider and Pharmacy Directory (PDF)
Provider and Pharmacy Directory - Spanish (PDF)
Service area map (PDF)
Member guide (PDF)
Prior Authorization List (PDF)
Prior Authorization List - Arabic (PDF)
Prior Authorization List - Hmong (PDF)
Prior Authorization List - Russian (PDF)
Prior Authorization List - Somali (PDF)
Prior Authorization List - Spanish (PDF)
Prior Authorization List - Vietnamese (PDF)
UCare Dental Overview (PDF)
TruHearing Hearing Aid Benefit (PDF)
Plan Rating Information (PDF)
Plan Rating Information - Spanish (PDF)
Member Release of Information Form (PDF)
Member Release of Information Form - Arabic (PDF)
Member Release of Information Form - Hmong (PDF)
Member Release of Information Form - Russian (PDF)
Member Release of Information Form - Somali (PDF)
Member Release of Information Form - Spanish (PDF)
Member Release of Information Form - Vietnamese (PDF)
Statement of Representative Form (PDF)
Power of Attorney short form
Deceased Member: Affidavit for the Collection of Personal Property (mncourts.gov)
Automatic Payment Form (PDF)
Online Automatic Payment Form
Claim Reimbursement Form (PDF)
Advance Directives (PDF)
Enrollment Forms
Fillable PDFs
2025 Medicare Enrollment Form - Metro (PDF)
2025 Medicare Enrollment Form - North (PDF)
2025 Medicare Enrollment Form - South (PDF)
2025 Medicare Enrollment Form - Metro - Spanish (PDF)
2025 Medicare Enrollment Form - South - Spanish (PDF)
2025 Medicare Enrollment Form - North - Spanish (PDF)
2025 UCare Medicare Enrollment Change Form (PDF)
Online Forms
2025 Dental Enrollment Form
2025 Medicare Enrollment Form - Metro
2025 Medicare Enrollment Form - North
2025 Medicare Enrollment Form - South
UCare Medicare Advantage Plans Overview (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)
UCare Medicare Advantage Plans Overview (PDF)
Metro
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
North
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
UCare Medicare Advantage Plans Overview (PDF)
Metro
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
North
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - North (PDF)
Plan Comparison Chart - North (PDF)
South
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - South (PDF)
Summary of Benefits - South - Spanish (PDF)
UCare Medicare Advantage Plans Overview (PDF)
Metro
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
North
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - North (PDF)
Plan Comparison Chart - North (PDF)
South
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage - Spanish (PDF)
UCare Medicare Advantage Plans Overview (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - South (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Summary of Benefits - South - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)
Plan Comparison Chart - South (PDF)
Part B Medical Injectable Drug Authorization List (PDF) updated 5/14/2025
UCare Medicare Advantage Plans Overview (PDF)
Annual Notice of Changes (PDF)
Annual Notice of Changes - Spanish (PDF)
Evidence of Coverage (PDF)
Evidence of Coverage - Spanish (PDF)
Summary of Benefits - Metro (PDF)
Summary of Benefits - North (PDF)
Summary of Benefits - South (PDF)
Summary of Benefits - Metro - Spanish (PDF)
Summary of Benefits - South - Spanish (PDF)
Plan Comparison Chart - Metro (PDF)
Plan Comparison Chart - North (PDF)
Plan Comparison Chart - South (PDF)
Part B Medical Injectable Drug Authorization List (PDF) updated 5/14/2025