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Provider FAQs: UCare Product Changes

Providers may continue to serve all active UCare members for the products listed in their Provider Participation Agreement with UCare.

Plan changes affect only members, not the provider’s ability to serve any active UCare members -- even if the provider is located in a county where UCare has exited.

Last updated: Oct. 1, 2025

Read the Oct. 1, 2025, Provider Bulletin

UCare announces 2026 service area reduction updates for UCare Connect + Medicare

Why did UCare make these changes?
UCare has made the difficult but necessary decision to adjust the service area of UCare Connect + Medicare (integrated, Special Needs BasicCare) beginning Jan. 1, 2026. This decision was part of a strategic roadmap established earlier in 2025 to ensure financial stability and mission continuity.

How long will the service area reduction last?
The UCare Connect + Medicare service area reduction is effective Jan. 1, 2026, and ongoing. UCare Connect + Medicare will continue to serve members in 14 counties: Anoka, Benton, Carver, Chisago, Dakota, Hennepin, Isanti, Mille Lacs, Ramsey, Scott, Sherburne, Stearns, Washington and Wright.

What counties are affected by the service area reduction?
UCare Connect + Medicare will no longer be available beginning Jan. 1, 2026 in the following counties: Aitkin, Becker, Blue Earth, Carlton, Cass, Chippewa, Clay, Cook, Cottonwood, Crow Wing, Faribault, Fillmore, Freeborn, Houston, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Red Lake, Redwood, Rice, Rock, Roseau, St. Louis, Swift, Todd, Wadena, Watonwan, Wilkin, Winona and Yellow Medicine.

See 2026 service area map for Connect + Medicare

What will happen to members impacted by the service area reduction?
Members may be able to switch to another Special Needs BasicCare (SNBC) option if one is offered and open for enrollment. If a member does nothing by mid-December, the member will be moved to fee-for-service (FFS) coverage in January. If a member qualifies for SNBC but didn’t choose a plan, in early 2026, the Minnesota Department of Human Services (DHS) will send the member a letter explaining SNBC benefits, the plans available in their county and how to enroll. UCare will work closely with DHS, counties and providers to make sure impacted members get clear information, help during the transition and continuity of care.

What role will providers have in transitioning enrollees to new health plans?
Providers play a key role in helping members understand their options and ensuring a smooth transition of care. While counties and DHS will manage the enrollment transition, providers may be contacted by members with questions.

Will authorizations for our patients be honored by their new health plan?
Authorizations valid prior to Jan. 1, 2026, will remain in place for covered services with UCare through the end of 2025. For 2026 and beyond, new plans or fee-for-service coverage will make authorization determinations. Members and providers should follow the standard process with the new payer effective Jan. 1, 2026.

How will inpatient hospital stay for a member be handled when the inpatient stay begins prior to Jan. 1, 2026, and ends after that date?
Inpatient stays that begin before Jan. 1, 2026, will be covered by the UCare member’s current plan through the date of discharge. The new plan effective Jan. 1, 2026, will not assume responsibility for these costs. This ensures members experience uninterrupted coverage and are not disrupted mid-stay.

How should we address UCare members who are canceling appointments because they are worried that they won’t be covered?
Reassure members that coverage continues without change through Dec. 31, 2025. Their UCare Connect + Medicare ID cards, benefits and provider access remain valid until that date. Encourage members to keep appointments and continue care as usual. Transition details for 2026 will be communicated to members in October.

Will there be any changes to UCare’s provider network as a result of the UCare Connect + Medicare service area reduction?
No. UCare’s overall provider network remains intact. Providers may continue to serve all active UCare members for the products listed in their Provider Participation Agreement with UCare. Plan changes affect only members, not the provider’s ability to serve any active UCare members – even if the provider is located in a county where UCare has exited.

Last updated: Oct. 6, 2025

Read the Sept. 5, 2025, Provider Bulletin

UCare to suspend certain Medicare Advantage products beginning in 2026

GENERAL QUESTIONS

Why did UCare make these changes?
Rising medical and pharmacy costs have made it increasingly difficult to sustain Medicare Advantage products while protecting UCare’s overall financial stability and mission. As a nonprofit focused on government programs, this decision allows us to continue serving Minnesotans through Medical Assistance (Medicaid), MinnesotaCare, Special Needs BasicCare and other programs.

Which UCare plans are impacted, and which plans will remain?
Ending after Dec. 31, 2025:

  • UCare Medicare Plans
  • UCare Your Choice
  • EssentiaCare
  • UCare Advocate
  • UCare Medicare Group plans

Continuing to offer in 2026:

  • UCare Medicare Supplement
  • UCare Individual & Family Plans
  • UCare Individual & Family Plans with M Health Fairview
  • Medical Assistance (Medicaid)
  • MinnesotaCare
  • Special Needs Basic Care (Connect)
  • Minnesota Senior Care Plus (MSC+) (Medicaid only for seniors)
  • Medical Assistance + Medicare (includes UCare’s Minnesota Senior Health Options and UCare Connect + Medicare) plans

UPDATED Oct. 6, 2025 - What happens for impacted members now?
No immediate changes in 2025. Members can continue to use their UCare ID cards, providers and benefits as usual through Dec. 31, 2025.

Impacted members will receive Centers for Medicare & Medicaid (CMS)-approved notices after Oct. 1, 2025, explaining their next steps.

They will need to choose new coverage that begins Jan. 1, 2026. Members can choose a new Medicare Advantage plan during the annual enrollment period, which typically runs from Oct. 15 to Dec. 7.

Members should watch for a letter from UCare that will provide all the details needed to get ready for 2026. That letter will arrive after Oct. 1.

Information for members.

What should providers do today?
Continue serving UCare members as you do today. There are no changes to contracts or network status.

How should we address UCare members who are canceling appointments because they are worried they won’t be covered?

  • For appointments prior to Jan. 1, 2026, reply with: “Because you are still a UCare member at this time, your visit will be covered, based on the terms of your member contract. Are you sure you want to cancel? If you have any questions about your coverage, please call the UCare Customer Service number listed on the back of your UCare member ID card.”
  • For appointments Jan. 1, 2026, or later, reply with: “Before you cancel, you may want to check with your new health plan to see if the appointment is covered.”

Will there be any changes to UCare’s provider network as a result of the change to Medicare Advantage product offerings?
Not at this time. Contracted providers should continue to serve impacted UCare members as they do today.

Will UCare be re-contracting with providers as a result of these changes?
If your current Provider Participation Agreement (PPA) with UCare includes Medicare Advantage products, those products will remain part of your contract.

NEW Oct. 6, 2025 - Will there be any changes to the timely filing guidelines for 2025 Medicare Advantage claims?
The 12-month timely filing requirement will remain in place for the runout on Medicare Advantage claims. For additional information on timely filing, please refer to 42 CFR 424.44 Time limits for filing claims.

UCare seems to be making some changes to its authorizations, policies, billing requirements and processes. How can providers stay updated on the latest information?
For the latest news and information, providers should sign up to receive Provider Bulletins and newsletters. Visit http://www.ucare.org/providers, scroll to the “News & Alerts” section of the page, then click the blue “Sign Up” button under “Newsletter Sign Up.” All news items are available by clicking “Provider News” on the top navigation bar and scrolling down that page to the News Archive.

Additionally, the provider website offers a host of information, including the Provider Manual, policies, authorization grids, claims and billing information, forms, training and education, and much more.

OTHER RELATED QUESTIONS

Will existing authorizations for our patients be honored by their new health plan?
Yes. Authorizations approved by UCare should be honored by the new health plan. To ensure continuity of care and appropriate transition of care, federal rules require health plans to ensure at least a 90-day transition period for any active course(s) of treatment when a member switches to a new plan. The new health plan must not disrupt or require reauthorization during this period. 

NEW Oct. 6 - How will we submit prior authorizations for services in 2026 if the member does not have their new plan information yet?
UCare is unable to enter prior authorization for individuals not actively enrolled. The individual should contact their new plan (once it is known) to determine the plan’s process for submitting prior authorization requests.

UPDATED Oct. 1, 2025 - How will inpatient hospital stays for a Medicare Advantage member be handled when they start prior to Jan. 1, 2026, and end after that date?
Inpatient stays that begin before Jan. 1, 2026, will be covered by the UCare member’s current plan through the date of discharge. The new plan effective Jan. 1, 2026, will not assume responsibility for these costs. This ensures members experience uninterrupted coverage and are not disrupted mid-stay.

UCare announced it will be launching a new provider portal with Availity. Will this still be occurring even with the Medicare Advantage changes?
Yes. UCare remains committed to supporting our providers and enhancing operational effectiveness. Earlier this year we partnered with Availity to develop our new provider portal. This work is moving forward as planned and is expected to roll out to providers in phases starting this fall.

Last updated: Oct. 6, 2025

Read the July 9, 2025, Provider Bulletin

2025 UCare enrollment changes for Medical Assistance FAQs

UCare and the Minnesota Department of Human Services (DHS) have agreed to expand UCare’s enrollment freeze in Prepaid Medical Assistance Program (PMAP), MinnesotaCare and Special Needs BasicCare (SNBC) UCare Connect starting July 1, 2025, as well as reduce UCare’s service area for PMAP and MinnesotaCare beginning Sept. 1, 2025.

To assist our provider partners in navigating these changes, UCare has developed this list of frequently asked questions. We will continue to add common questions and update this document with additional information as needed. We recommend that you bookmark this document for future reference.

Why did UCare make these changes?
At the beginning of 2025, UCare and DHS agreed to temporarily freeze UCare’s new enrollment into PMAP in all counties except Hennepin County to mitigate financial losses and constraints. This was expected to result in gradual enrollment losses throughout 2025. However, members continue to enroll at higher rates than anticipated, and medical expenses continue to increase significantly. As a result, UCare and DHS agreed to further freeze enrollment in all PMAP and MinnesotaCare counties and some non-integrated SNBC (Connect) counties, as well as reduce UCare’s service area for PMAP and MinnesotaCare beginning Sept. 1, 2025.

How long will the enrollment freeze last?
The enrollment freeze is anticipated to last through the remainder of 2025, at which time UCare and DHS will evaluate if the freeze needs to continue into 2026.

How long will the Service Area Reduction last?
The Service Area Reduction will start Sept. 1, 2025, and continue until the next DHS procurement is effective.

What counties are affected by the Service Area Reduction?
Beginning Sept. 1, 2025, until the next DHS procurement is effective, UCare will exit the following counties for PMAP and MinnesotaCare: Benton, Chisago, Crow Wing, Pennington, Ramsey, Roseau, St. Louis, Sherburne, Stearns, Wadena and Wright.

NEW Oct. 1, 2025 - See the Product Map for PMAP and MinnesotaCare.

What will happen with members impacted by the enrollment freeze or Service Area Reduction?
Members in a county with only an enrollment freeze will not be affected. They will continue to be in their plan and receive coverage as they always have. They can see their doctors and receive the same services. They will not see any changes and do not need to take any action.

The members in counties impacted by the Service Area Reduction will have no gap in Medical Assistance or MinnesotaCare coverage. They will remain UCare members through Aug. 31, 2025, and will continue to see their doctors and receive the same services they always have. They will then transition to their new health plan on Sept. 1, 2025.

In July, DHS started sending a Health Plan Choice letter with information about other health plans available to current UCare members in impacted counties. Enrollees may choose a different plan, or DHS will default them to a plan if no choice is elected.

How will enrollees be notified if they need to choose a new health plan by Sept. 1?
Enrollees impacted by the service area reduction, meaning they can no longer remain enrolled with UCare as of Sept. 1, received communication from DHS in early July.

This Health Plan Choice letter tells them that UCare will no longer be their plan as of Sept. 1, 2025, and provide them with their health plan options for the county.

The enrollee may choose a different health plan by returning the plan choice form by July 28, or DHS will default them to a plan if the enrollee does not make an active choice.

Sample enrollee letter templates:

UCare Special Enrollment Period Notice example 1

UCare Special Enrollment Period Notice example 2

UCare Special Enrollment Period Notice example 3

Please note: the plan options listed in the templates may change based on the county, so any plan options showing are not necessarily what every enrollee will see.

Can we get a list of members impacted by the Service Area Reduction?
Unfortunately, there is not a list of members impacted by this change that is being shared. We encourage providers to reach out directly to DHS with any member-related questions they may have about the Service Area Reduction.

What role will providers have in transitioning enrollees to new health plans?
Providers do not need to take any action regarding continuity of care for impacted enrollees. UCare will share information about a member’s prescriptions, authorizations and special services with the new plan through DHS.

Impacted enrollees may contact your office to see if you are in network with one of the other plan choices available to them.

For additional information, please contact DHS. Their contact information is available at https://mn.gov/dhs/general-public/about-dhs/contact-us/.

Will authorizations for our patients be honored by their new health plan?
In general, authorizations approved by UCare should be honored by the new health plan. UCare will work with DHS to share data and information regarding authorizations for prescription drugs, pregnancy, surgical, mental health, substance use disorder, orthodontics, special transportation and care management. DHS will share this information with the enrollee’s new health plan.

In addition, to ensure appropriate transition of care, all health plans are required to honor an enrollee’s current course of treatment for 120 days for many acute or life-threatening conditions, pregnancy, enrollees with disabilities or for culturally appropriate care.

How will inpatient hospital stays for a member be handled when they start prior to Sept. 1, 2025, and end after that date?
Per section 3.4.3.3. (Notification and Termination of Enrollment) of the 2025 Prepaid Medical Assistance and MinnesotaCare (Families and Children) contract, when a member is receiving inpatient hospital services prior to Sept. 1, 2025, that continue until after that date, UCare will be responsible for the inpatient hospital services and associated ancillary services until midnight (Central Time) on the first day following discharge from the hospital.

How should we address UCare members who are canceling appointments because they are worried they won’t be covered?

  • For appointments prior to Sept. 1, 2025: Because you are still a UCare member at this time, your visit will be covered. Are you sure you want to cancel? If you have any questions about your coverage, please call the Customer Service number listed on the back of your UCare member ID card.
  • For appointments Sept. 1, 2025, or later: Before you cancel, you may want to check with your new health plan to see if the appointment is covered. Do you know how to contact your new plan?
    • If yes: Please give them a call to check your coverage. If the appointment isn’t covered and you still want to cancel, you can call us back.
    • If no: You should receive a letter from the Minnesota Department of Human Services and your new plan. This will have all of the information you need to contact the new plan. If you do not receive this information, you can call the Minnesota Department of Human Services Health Care Consumer Support line at 651-431-3722 or toll-free at 1-833-970-0047.

Will there be any changes to UCare’s provider network as a result of the Medical Assistance enrollment changes?

If your current Provider Participation Agreement (PPA) with UCare includes the Medical Assistance products impacted by the enrollment changes, you should continue to serve eligible UCare members enrolled in these products, as outlined in the PPA. It is the member’s enrollment that is impacted by the enrollment freeze and/or Service Area Reduction (SAR), not the provider’s network status.

Will UCare be re-contracting with providers as a result of these changes?
UCare will not be re-contracting due to these changes. Our provider network will remain the same.

Is UCare leaving Medical Assistance (Medicaid) or MinnesotaCare?
No. UCare remains deeply committed to Medical Assistance and MinnesotaCare. These decisions are about strengthening UCare’s position for the long haul to best serve members, providers and the community partners. They are not about exiting the market. UCare will have the opportunity to re-enter these counties during the next DHS procurement.

UPDATED Oct. 6, 2025 - Where can I find additional information on these changes?

UCare seems to be making some changes to its authorizations, policies, billing requirements and processes. How can providers stay updated on the latest information?
For the latest news and information, providers should sign up to receive Provider Bulletins and newsletters. Visit www.ucare.org/providers, scroll to the “News & Alerts” section of the page, then clicking the blue “Sign Up” button under “Newsletter Sign Up.” All news items are available by clicking “provider news” on the top navigation bar and scrolling down that page to the News Archive.

Additionally, the provider website offers a host of information, including the Provider Manual, policies, authorization grids, claims and billing information, forms, training and education, and much more.