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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) 

Medicare Coverage Updates

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)

Dental Enrollment Form (PDF)

Online Forms
2025 Dental Enrollment Form
2025 Medicare Enrollment Form - Metro
2025 Medicare Enrollment Form - North
2025 Medicare Enrollment Form - South