Provider FAQs: UCare Product Changes
Summary of 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.
| Effective date | Type of change | Products affected | Counties impacted |
| 7/1/2025 | Enrollment Freeze | Prepaid Medical Assistance Program (PMAP) | Enrollment freeze in effect for all counties |
| 7/1/2025 | Enrollment Freeze |
MinnesotaCare Updated 9/1/2025 |
Enrollment freeze in effect for Anoka, Carver, Dakota, Hennepin, Scott and Washington |
| 7/1/2025 | Enrollment Freeze | UCare Connect (non-integrated, Special Needs BasicCare | Enrollment freeze in effect for Aitkin, Anoka, Becker, Benton, Carlton, Carver, Chippewa, Chisago, Cook, Cottonwood, Crow Wing, Dakota, Fillmore, Freeborn, Hennepin, Isanti, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Le Sueur, Lincoln, Lyon, Mahnomen, Mille Lacs, Morrison, Murray, Nicollet, Nobles, Norman, Olmsted, Ramsey, Red Lake, Redwood, Rice, Rock, St. Louis, Scott, Sherburne, Stearns, Swift, Todd, Wadena, Washington, Wilkin, Wright and Yellow Medicine |
| 9/1/2025 | Service Area Reduction | PMAP | Service area reduction in effect for Benton, Chisago, Crow Wing, Pennington, Ramsey, Roseau, St. Louis, Sherburne, Stearns, Wadena and Wright |
| 9/1/2025 | Service Area Reduction | MinnesotaCare | Service area reduction in effect for Benton, Chisago, Crow Wing, Pennington, Ramsey, Roseau, St. Louis, Sherburne, Stearns, Wadena and Wright |
| 1/1/2026 | Product Suspension | Medicare Advantage (UCare Medicare Plans, EssentiaCare | Suspension in effect for all counties |
| 1/1/2026 | Product Suspension | UCare Connect + Medicare (integrated, Special Needs BasicCare) | UCare will exit all counties. |
| 1/1/2026 |
Product Suspension | UCare's Minnesota Senior Health Options (MSHO) | UCare will exit all counties. |
| 1/1/2026 | No Changes | Minnesota Senior Care Plus (MSC+) | Not applicable |
FAQ and Resources
UCare to discontinue dual eligible special needs plans beginning in 2026
Last updated Dec. 5, 2025
UCare will discontinue all dual eligible special needs plans or D-SNPs (UCare’s Minnesota Senior Health Options and UCare Connect + Medicare) as of Dec. 31, 2025. UCare and Medica worked diligently with the Centers for Medicare & Medicaid Services (CMS) and the Minnesota Department of Human Services (DHS) to find a path to allow dual members to transition alongside Medicaid and Individual & Family Plans (IFP) products. Due to regulatory constraints and a mis-matched service area between UCare and Medica, the D-SNP transition was not allowed to move forward.
The following FAQs will be updated as new information becomes available.
What should providers do today?
Continue serving UCare’s Minnesota Senior Health Options (MSHO) and UCare Connect + Medicare members as you currently do throughout the rest of 2025. There are no changes to benefits, coverage, contracts or network status for 2025.
What will happen to members impacted by the change?
- MSHO: Members will receive a letter in the mail in the next two weeks (exact mailing date forthcoming). The letter will inform them that their UCare MSHO plan is ending on Dec. 31, 2025. If a member does not select a new plan, for Medicaid they will default to UCare’s Minnesota Senior Care Plus (MSC+) plan. For Medicare coverage, all members defaulting will be covered by Original Medicare for Parts A and B and auto enrolled by CMS into a Medicare Part D plan (Humana Basic Rx Plan through Humana Insurance Company) for 2026.
- UCare Connect + Medicare: Members will receive a letter in the next two week (exact mailing date forthcoming). The letter will inform them that their UCare Connect + Medicare plan ends on Dec. 31, 2025. If no plan selection is made, they will default to UCare’s Connect plan for Medical Assistance (Medicaid). For Medicare coverage, all members defaulting will be covered by Original Medicare for Parts A and B and auto enrolled by CMS into a Medicare Part D plan (Humana Basic Rx Plan through Humana Insurance Company) for 2026. There are two groups of Connect + Medicare members:
- Member residing in the 14-county Service Area Reduction (Anoka, Benton, Carver, Chisago, Dakota, Hennepin, Isanti, Mille Lacs, Ramsey, Scott, Sherburne, Stearns, Washington, Wright). Will receive a letter notifying them of the plan ending. The default rules apply if they do not select a new plan.
- Members who already received a termination notice earlier this year. The same default process applies. If they do not make a plan selection, they will default to UCare Connect and be assigned a Medicare Part D plan (Humana Basic Rx Plan through Humana Insurance Company) effective Jan. 1, 2026.
What happens if a plan is not available in the impacted member’s county?
The member will be defaulted to UCare Medical Assistance (Medicaid) plans (MSC+ or UCare Connect) if they do not choose another plan. Providers should use MN-ITS to see which plan the person has in 2026. All members will have a new plan if they were on UCare MSHO or UCare Connect + Medicare in 2025.
Where to send members with questions
Advise members to:
- Contact their UCare Care Coordinator
- Direct member questions or concerns to UCare Customer Services for UCare Connect + Medicare at 1-855-260-9707, UCare Connect at 1-877-903-0061, UCare MSC+ at 1-800-203-7225, and UCare MSHO 1-866-280-7202.
- If they are on Medicare Advantage or MSHO, call Minnesota Aging Pathways, formerly the Minnesota Senior LinkAge Line, at 1-800-333-2433. They are available Monday through Friday, 8am to 4:30pm.
- If they are on UCare Connect + Medicare, call Disability HUB at 1-866-333-2466. They are available Monday through Friday, 8:30am to 5pm.
- Talk to a broker and other community organizations.
Last updated: Dec. 5, 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)
What happens to 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 received Centers for Medicare & Medicaid (CMS)-approved notices 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 have received a letter from UCare that provides all the details needed to get ready for 2026.
Medicare Advantage plan closure resources
EssentiaCare plan closure resources
Member notification letters
Example 4
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.
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.
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.
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.
Last updated: Dec. 5, 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) 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 page 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 continues to enroll at higher rates than anticipated, and medical expenses continued 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.
What happens with members impacted by the enrollment freeze?
Members in a county with an enrollment freeze are not affected. They 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.
How long will the Service Area Reduction last?
The Service Area Reduction started Sept. 1, 2025, and will continue until the next DHS procurement is effective.
What counties are affected by the Service Area Reduction?
From 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.
See the Product Map for PMAP and MinnesotaCare.
What happens with members impacted by the enrollment freeze?
Members in a county with an enrollment freeze are not affected. They 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.
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 is sharing 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 is working 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 is 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?
Suggested talking points:
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 have received a letter from the Minnesota Department of Human Services and your new plan. This has all of the information you need to contact the new plan. If you did 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.
Where can I find additional information on these changes?
- Member information:
- DHS Maps of health plan service areas by county
- Health Care Consumer Support line - 651-431-3722 or 1-833-970-0047, or contact county of residence
- UCare plan closure frequently asked questions
- Provider information:
- UCare’s July 9, 2025, Provider Bulletin
- MN-ITS for the latest enrollment data
- MHCP provider news and updates / MHCP provider news and updates archive
- Managed Care Organizations (MCO) contacts for MHCP providers
- MHCP Provider Resource Center - 651-431-2700 or 1-800-366-5411
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.