UCare Minnesota - UCare Bronze
Yearly Deductible
Out-of-Pocket Maximum
Primary Care Visit
First 3 visits at $60 Copay,
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Specialist Visit
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Other Practitioner Office Visit
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Preventive Care/Screening/Immunization
No Charge
50% Coinsurance after deductible
X-rays and Diagnostic Imaging
35% Coinsurance after deductible
50% Coinsurance after deductible
Imaging (CT/PET scans, MRIs)
35% Coinsurance after deductible
50% Coinsurance after deductible
Generic Drugs
$15 Copay
100% Coinsurance
Preferred Brand Drugs
$200 Copay
100% Coinsurance
Non-Preferred Brand Drugs
40% Coinsurance after deductible
100% Coinsurance
Specialty Drugs
40% Coinsurance after deductible
100% Coinsurance
Outpatient Services
35% Coinsurance after deductible
50% Coinsurance after deductible
Emergency Room
35% Coinsurance after deductible
35% Coinsurance after deductible
Ambulance Services
35% Coinsurance after deductible
35% Coinsurance after deductible
Urgent Care Services
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Inpatient Hospital Services
35% Coinsurance after deductible
50% Coinsurance after deductible
Inpatient Physician and Surgical Services
35% Coinsurance after deductible
50% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
35% Coinsurance after deductible
50% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services
35% Coinsurance after deductible
50% Coinsurance after deductible
Prenatal and Postnatal Care
No Charge
50% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care
35% Coinsurance after deductible
50% Coinsurance after deductible
Home Healthcare Services
35% Coinsurance after deductible
50% Coinsurance after deductible
Outpatient Rehabilitation Services
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Habilitation Services
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Skilled Nursing Facility
35% Coinsurance after deductible
50% Coinsurance after deductible
Durable Medical Equipment
35% Coinsurance after deductible
50% Coinsurance after deductible
Hospice Services
35% Coinsurance after deductible
50% Coinsurance after deductible
Acupuncture
Not covered
Not covered
Rehabilitative Occupational and Rehabilitative Physical Therapy
$60 Copay
35% Coinsurance after deductible
35% Coinsurance after deductible
50% Coinsurance after deductible
Well Baby Visits and Care
No Charge
50% Coinsurance after deductible
Allergy Testing
35% Coinsurance after deductible
50% Coinsurance after deductible
Diabetes Education
No Charge
50% Coinsurance after deductible
Nutritional Counseling
No Charge
50% Coinsurance after deductible
Eye Exam for Children
No Charge
50% Coinsurance after deductible
Eyeglasses for Children
35% Coinsurance after deductible
100% Coinsurance
Hearing Aids for Children
35% Coinsurance after deductible
100% Coinsurance
Basic Dental Care (Adult)
Not covered
Not covered
Basic Dental (Child)
35% Coinsurance after deductible
100% Coinsurance
Dental Checkup (Child)
No Charge
50% Coinsurance after deductible
Major Dental Care (Adult)
Not covered
Not covered
Major Dental Care (Child)
35% Coinsurance after deductible
100% Coinsurance