Essence Advantage (HMO)

 Benefits at a Glance: We Have Got You Covered From Head to Toe

The following table highlights just some of the many benefits available to you as a valued Essence Advantage member. For more details and a complete list of benefits, please review our Summary of Benefits or Evidence of Coverage which can be downloaded by clicking the links below.  

Hospital & Medical Coverage

Your Essence Healthcare plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments.
Essence Advantage (HMO)
Monthly Premium $0
Maximum Out-of-Pocket Limit  What’s this? $3,300 Per Year
Annual Medical Deductible $0 Per Year
Preventive Care/Screenings $0 Copay
Primary Care Doctor Visits $10 Copay
Specialty Care Doctor Visits $45 Copay
Urgent Care $30 Copay
Emergency Room Care $120 Copay
Lab Services $20 Copay
Home Health Care 100% Coverage
Chiropractic Services $20 Copay
Inpatient Hospital Care $310 Copay Per Day for Days 1-7, $0 Per Day for Day 8 and beyond
Outpatient Surgery at Hospital $250 Copay
Outpatient Surgery at Ambulatory Surgical Center $175 Copay

Part D Drug Coverage

This table shows the drug tiers associated with your plan, and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.  
Essence Advantage (HMO)
Preferred Pharmacies* Other Network Pharmacies
Annual Part D Deductible $0 Per Year $0 Per Year
Tier 1 – Preferred Generics $0 Copay $7 Copay
Tier 2 – Generics $0 Copay $12 Copay
Tier 3 – Preferred Brands $42 Copay $47 Copay
Tier 4 – Non-Preferred Brands $85 Copay $95 Copay
Tier 5 – Specialty Drugs 33% Co-insurance 33% Co-insurance
Tier 6 – Insulins $0 Copay $0 Copay
Initial Coverage Limit $4,020 Per Year $4,020 Per Year

Part D drug benefit expenses are not covered under the maximum out-of-pocket limit. 

*Schnucks, CVS, Target and Pharmax are Essence preferred pharmacies. Other pharmacies are available in our network.

Extra Benefits

Your Essence Healthcare plan includes many valuable extra benefits not offered by Original Medicare or Medicare supplement plans–at no additional cost to you.
Essence Advantage (HMO)
Routine Eye Exam $35 Copay
Eyeglass Frames or Contacts** $0 Copay
Preventive Dental Visits $35 Copay
Over-the-Counter (OTC) Items $50 Per Quarter
Transportation Assistance 20 one-way trips per year
SilverSneakers® Fitness Benefits What’s this? Included at no additional cost
Travel Coverage Urgent and emergent care is available worldwide

Extra benefit expenses are not covered under the maximum out-of-pocket limit.

**Our eyewear benefit is limited to one pair of eyeglass lenses and frames every 2 years.

Important Plan Documents

Download: Summary of Benefits
Download: Annual Notice of Change
Download: Evidence of Coverage
Download: Provider Directory
Download: Drug Formulary
Download: Formulary Change Notice
Extra Help: Low Income Subsidy Information
View: Multi-Language Insert
View: CMS Star rating for this plan