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Minnesota Insurance Update 2025

Industry News ·

Each year we like to summarize any significant changes we’ve found in the managed care programs we service in Minnesota so our customers can prepare for the new year. Here are a few notes we’ve collected as 2024 ends on what to expect in 2025. We encourage providers to contact their contracted plans regarding their dispensing or exam agreements. EyeKraft does not have vendor relationships with plans not listed below, and we’re unable to provide benefit or administrative information on any other plans. If you have questions about benefits or coverage for plans not listed below, please contact your contract manager or provider services representatives for the plan in question. These notes may not be all inclusive of changes, and this information is subject to change, so review any communications from your accepted plans to prevent surprises. Thank you!

Maps:

The following are the maps of health plan service areas by county located on the Minnesota Department Of Human Services site. Maps are effective from Jan 1 2025 to Dec 31 2025.

Medica:

MEDICA PROVIDER SERVICES – 800-458-5512

EyeKraft processes materials claims directly to Medica for the following plans:

  • Prepaid Medical Assistance Program (PMAP)
  • MinnesotaCare
  • Special Needs Basic Care with Medicare Medica Accessibility Solution® Enhanced
  • Special Needs Basic Care (SNBC) Medica Accessibility Solution
  • Minnesota Senior Health Options (MSHO) Medica DUAL Solution
  • Minnesota Senior Care Plus (MSC+) Medica Choice Care℠ MSC+

NO NEW MEDICA CHANGES FOR 2025

Continued services for 2025

27 counties on the Pre-Paid Medical Assistance plans.

Anoka, Becker, Carver, Chisago, Clay, Crow Wing, Dakota, Hennepin, Kittson, Mahnomen, Marshall, Norman, Olmsted, Otter Tail, Pennington, Polk, Ramsey, Red Lake, Rice, Roseau, Scott, Sherburne, St. Louis, Stearns, Wadena, Washington, Wilkin, and Wright

This is a Prepaid Medical Assistance program exclusive to Medica, so checking eligibility for these patients is easiest on the Medica Portal. www.medica.com

  • To register for Medica’s portal call 1-800-458-5512.
  • Please note, the New Payer ID for these two plans are MEDMI
  • Group numbers start with the letter “A” for this plan.
  • This plan is basic coverage with frames and lenses.
  • Dispensing providers should verify registration for these plans with their clearinghouses.
  • If unregistered, paper claims for exams and dispensing can be submitted to: Medica Government Programs, PO BOX 21342, Eagan MN 55121-0342.
  • EyeKraft will not be able to register providers on the Medica Portal

20 counties on the Medica Minnesota Care plan

Becker, Chisago, Clay, Crow Wing, Hennepin, Kanabec, Kittson, Mahnomen, Marshall, Norman, Otter Tail, Pennington, Polk, Red Lake, Roseau, Sherburne, St. Louis, Wadena, Wilkin, and Wright.

38 counties on the Special Needs Basic Care SNBC with Medicare Medica Accessibility Solution Enhanced Plan

Aitkin, Anoka, Becker, Carlton, Carver, Chisago, Cook, Crow Wing, Dakota, Fillmore, Freeborn, Hennepin, Isanti, Kanabec, Kandiyohi, Kittson, Koochiching, Lake, Le Sueur, Mahnomen, Mille Lacs, Morrison, Murray, Nicollet, Norman, Olmsted, Ramsey, Red Lake, Rice, Rock, Scott, Sherburne, St. Louis, Todd, Wadena, and Washington.

  • Medica will continue with their Anti-Reflective Coating benefit for members with groups #07xxx (Special Needs Basic Care Enhanced) & 08xxx (Minnesota Senior Health Option Plan).

10 Counties on the Minnesota Senior Health Options (MSHO) Medica DUAL Solution Plan

Anoka, Benton, Carver, Chisago, Dakota, Hennepin, Ramsey, Scott, Sherburne, and Stearns.

  • Medica will continue with their Anti-Reflective Coating benefit for members with groups #07xxx (Special Needs Basic Care Enhanced) & 08xxx (Minnesota Senior Health Option Plan).

11 counties on the Minnesota Senior Care Plus (MSC+) Medica Choice Care℠ MSC+ Plan

Aitkin, Anoka, Becker, Benton, Blue Earth, Carlton, Carver, Cass, Chisago, and Clay.

Medica Links

UCare:

UCARE PROVIDER SERVICES – 1-888-531-1493

EyeKraft Processes claims directly to UCare for the following plans:

  • Minnesota Care
  • Minnesota Senior Care Plus
  • Minnesota Senior Health Options (exclusive to EyeKraft; claims elsewhere will be denied)
  • Prepaid Medical Assistance Program
  • UCare Connect
  • UCare Connect Plus Medicare (exclusive to EyeKraft; claims elsewhere will be denied)

NEW FOR 2025!

UCare will cover 1 replacement pair of lenses with supplemental benefits under the UCare connect plus Medicare and the Minnesota Senior Health Options plan due to loss or damage.

Continued services for 2025

Supplemental Benefits

UCare will continue to provide supplemental anti-reflective coating, photochromic lenses, tints, and progressives on their UCare connect plus Medicare and the Minnesota Senior Health Options plans ONLY in 2025.

Benefits are only covered when obtained from EyeKraft. Coverage for UCare supplemental eyewear through EyeKraft is not subject to medical necessity requirements and is not limited to specific diagnoses. The benefit does not require prior authorization. Members can use the benefit once every year.

NEW FOR 2025! – UCare will cover 1 replacement pair of lenses with supplemental benefit treatments due to loss or damage.

  • These are covered benefits–no prior authorization or diagnostic code is needed. This is at no cost to the member.
  • These services can only be processed for UCare through EyeKraft.
  • It will cover this benefit 1 time per calendar year, with 1 replacement for loss or damage allowed.
  • Progressives will be EyeKraft’s DLS Everyday+. This is a non-compensated back-sided digital design. Design upgrades (paid out of pocket) are not allowed.
  • Anti-reflective coating will be EyeKraft’s ClearKraft2.
  • If a patient has supplemental coverage for anti-reflective coating, the office will not be billed. EyeKraft must always bill the eligible patient’s insurance for the product if the patient is eligible.
  • Anti-reflective coating orders are complete frame and lens orders, anti-reflective coating will not be added to existing lenses.
  • Photochromics will be lab choice based on Rx, availability, and lens design.
  • Only standard solid or gradient tints may be used under supplemental plans. Therapeutic and specialty tints require medical necessity and diagnostic codes and are not covered under the MSHO and UCare Connect plans.
  • Photochromics or tints may be ordered under the supplemental benefit, but not both. Providers do have the option of adding the tint and billing the patient.
  • Providers will continue to bill exam and dispensing fees as usual. Providers are allowed to bill the trifocal dispensing code for supplemental progressive lens benefits. UCare will not be adding a progressive dispensing code.

IMPORTANT!
For UCare Supplemental Benefits (MSHO and UCare Connect plans)…

  • Progressives will only be covered one time. If a patient has a qualified remake for power or other changes, a single vision or lined multi-focal will be required. There is no benefit exception for this. Patients cannot pay the difference between a standard job and the progressive. They may upgrade, but they must pay for the entire order, including the frame. These will be billed to the ECP at savings package pricing. The exception to the 1 pair rule is for replacement of a damaged or lost pair during the calendar year.
  • Tints are only covered one time, however UCare will accept tints needed for qualified medical necessity. Medically necessary tints must be submitted with a valid diagnostic code. Patients can also purchase tints as an add on (not an upgrade). Purchased tints will be billed to the eye care provider. The exception to the 1 pair rule is for replacement of a damaged or lost pair during the calendar year.
  • Photochromics are covered one time, however UCare will accept photochromics needed for qualified medical necessity. Medically necessary photochromics must be submitted with a valid diagnostic code supplied by the provider. Photochromic lenses are upgrades and not add-ons, so patients may not purchase photochromics separately. If a patient wants to purchase photochromics, they must pay for the entire order, including the frame, and EyeKraft will bill the entire order to the eye care provider under the Savings package price list. The exception to the 1 pair rule is for replacement of a damaged or lost pair during the calendar year.
  • Anti-Reflective coating will only be covered one time. There are no benefit exceptions for medical necessity with anti-reflective coating. Patients may purchase anti-reflective coating from the ECP as an add-on service, and these will be billed directly to the ECP. The exception to the 1 pair rule is for replacement of a damaged or lost pair during the calendar year.

44 counties on the UCare Pre-Paid Medical Assistance Plan

Aitkin, Anoka, Benton, Blue Earth, Carlton, Carver, Cass, Chisago, Cook, Crow Wing, Dakota, Faribault, Fillmore, Freeborn, Hennepin, Houston, Isanti, Koochiching, Lake, Lake of the Woods, Le Sueur, Martin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Olmsted, Pennington, Pine, Ramsey, Rice, Rock, Roseau, Scott, Sherburne, Stearns, St. Louis, Todd, Wadena, Washington, Watonwan, Winona and Wright

  • Basic frame and lenses are covered.
  • Photochromic lenses are covered with a diagnostic code and medical necessity.
  • Members are allowed to pay providers privately for anti-reflective coating.
  • Progressives and anti-reflective coating are NOT covered with any diagnostic code.

44 counties on the UCare Minnesota Care Plan

Aitkin, Anoka, Benton, Blue Earth, Carlton, Carver, Cass, Chisago, Cook, Crow Wing, Dakota, Faribault, Fillmore, Freeborn, Hennepin, Houston, Isanti, Koochiching, Lake, Lake of the Woods, Le Sueur, Martin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Olmsted, Pennington, Pine, Ramsey, Rice, Rock, Roseau, Scott, Sherburne, Stearns, St. Louis, Todd, Wadena, Washington, Watonwan, Winona and Wright.

  • Basic frame and lenses are covered.
  • Photochromic lenses are covered with a diagnostic code and medical necessity.
  • Progressives and anti-reflective coating are NOT covered with any diagnostic code.

66 counties on the UCare Minnesota Senior Health Option Plan (MSHO)

Aitkin, Anoka, Becker, Benton, Blue Earth, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Faribault, Fillmore, Freeborn, Hennepin, Houston, Isanti, Jackson, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood, Rice, Rock, Roseau, Saint Louis, Scott, Sherburne, Stearns, Swift, Todd, Wabasha, Wadena, Washington, Watonwan, Winona, Wright and Yellow Medicine

  • Progressives, anti-reflective coating, and photochromic lenses are covered one time per calendar year (with an exception for 1 lost or damaged replacement.) No diagnostic codes are required. This is the member’s benefit under this plan and provider offices will not be billed.
  • Additional orders with supplemental benefits will be rejected.
  • If an additional order is needed, members are allowed to have a covered FT 28 bifocal or FT Trifocal. If the member chooses to pay for the progressive, they must pay for the entire order, including the frame, and the entire order will be billed to the provider.
  • Photochromic lenses will be covered with a diagnostic code if medically necessary.
  • Members are allowed to pay the provider for anti-reflective coating.

66 counties on the UCare Minnesota Senior Care Plus MSC+ Plan

Aitkin, Anoka, Becker, Benton, Blue Earth, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Cook, Cottonwood, Crow Wing, Dakota, Dodge, Faribault, Fillmore, Freeborn, Hennepin, Houston, Isanti, Jackson, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood, Rice, Rock, Roseau, Saint Louis, Scott, Sherburne, Stearns, Swift, Todd, Wabasha, Wadena, Washington, Watonwan, Winona, Wright and Yellow Medicine.

  • Basic frame and lenses are covered.
  • Photochromic lenses are covered with a diagnostic code
  • Members are allowed to pay the provider for anti-reflective coating.
  • Progressives and anti-reflective coating are NOT covered benefits with any diagnostic code.

67 counties on the UCare Connect Plan

Aitkin, Anoka, Becker, Benton, Blue Earth, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Cook, Cottonwood, Crow Wing, Dakota, Faribault, Fillmore, Freeborn, Hennepin, Houston, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood, Rice, Rock, Roseau, Scott, Sherburne, St. Louis, Stearns, Swift, Todd, Wadena, Washington, Watonwan, Wilkin, Winona, Wright and Yellow Medicine.

  • Basic frame and lenses are covered.
  • Photochromic lenses are covered with a diagnostic code
  • Members are allowed to pay the provider for anti-reflective coating.
  • Progressives and anti-reflective coating are NOT covered benefits with any diagnostic code.

67 counties on the UCare Connect + Medicare Plan

Aitkin, Anoka, Becker, Benton, Blue Earth, Carlton, Carver, Cass, Chippewa, Chisago, Clay, Cook, Cottonwood, Crow Wing, Dakota, Faribault, Fillmore, Freeborn, Hennepin, Houston, Isanti, Itasca, Jackson, Kanabec, Kandiyohi, Kittson, Koochiching, Lac qui Parle, Lake, Lake of the Woods, Le Sueur, Lincoln, Lyon, Mahnomen, Marshall, Martin, Mille Lacs, Morrison, Mower, Murray, Nicollet, Nobles, Norman, Olmsted, Otter Tail, Pennington, Pine, Polk, Ramsey, Red Lake, Redwood, Rice, Rock, Roseau, Scott, Sherburne, St. Louis, Stearns, Swift, Todd, Wadena, Washington, Watonwan, Wilkin, Winona, Wright and Yellow Medicine.

  • Progressives, anti-reflective coating, and photochromic lenses are covered one time per calendar year (with a 1 time exception for loss or damage). No diagnostic codes are required. This is the member’s benefit and provider offices will not be billed.
  • Additional orders will be rejected.
  • If an additional order is needed, members are allowed to have a covered FT 28 bifocal or FT Trifocal. If the member chooses to pay for the progressive, they must pay for the entire order, including the frame, and the entire order will be billed to the provider.
  • Photochromic lenses will be covered with a diagnostic code if medically necessary.
  • Members are allowed to pay the provider for anti-reflective coating

UCare Links

South Country Health Alliance:

SOUTH COUNTRY PROVIDER SERVICES – 1-888-633-4055

EyeKraft Processes claims directly to SCHA for the following plans:

  • Minnesota Care
  • Minnesota Senior Care Plus MSC+
  • Prepaid Medical Assistance Program
  • Minnesota Senior Health Options (MSHO)
  • Special Needs Basic Care (SNBC)

IMPORTANT CHANGE EFFECTIVE JANUARY 1, 2025

From South Country Health Alliance: “Earlier this year, South Country Health Alliance’s member/owner Kanabec county voted to withdraw their membership in South Country Health Alliance (SCHA), as of January 1, 2025. As a result of this decision SCHA will not be a plan option for qualifying individuals residing in Kanabec county for any of our current products: Medical Assistance (PMAP), MinnesotaCare, MSC+, SingleCare, SharedCare (both SNBC programs) and SeniorCare Complete (MSHO) and AbilityCare, both programs for dual eligible individuals. To ensure your 2025 claims are processed quickly and accurately, please advise your scheduling staff to verify new insurance coverage with patients previously enrolled with South Country Health Alliance.”

  • Brown, Dodge, Goodhue, Sibley, Steele, Wabasha, and Waseca.

SCHA Links

VSP:

You read that right! EyeKraft is now a VSP lab provider. VSP eye care providers can now order their frames and lenses through EyeKraft. We manufacture all TechShield and Unity Brands in house, and are producing Varilux on-site as well. If you’d like to have EyeKraft service and quality with your VSP orders, add contract lab 0533 to your Eyefinity connections today.

Finally, just a reminder that for basic Minnesota insurance plans upgrades are not allowed. However, add-ons such as anti-reflective coatings, tints, rolls and polish, Chemistrie Clips, facet and specialty edging, and mirror coatings can be offered as allowed add-ons to basic benefit pairs. Call customer service at 1-888-455-2022 to explore these options further.

Also, check out our deluxe frames catalog (archived PDF). These frames are excellent options for third party insurance and value package private pay orders.

Deluxe frames can be used for Minnesota Healthcare Programs serviced by EyeKraft for all children. Adults are eligible for these frames for MHCP products under specific conditions. Please check with the lab.