Essence Healthcare Plans in Your Area

  Essence Advantage® (HMO) Essence Advantage Plus® (HMO) Essence Advantage Select (HMO)
Medical & Hospital
Monthly Premium $0 $73 $0
Maximum Out-of-Pocket Limit $1,900 Per Year $1,700 Per Year $2,900 Per Year
Annual Deductible $0 $0 $0
Preventive Care/Screenings $0 Copay $0 Copay $0 Copay
Primary Care Physician Visits $0 Copay $0 Copay $0 Copay
Specialist Doctor Visits $35 Copay $30 Copay $45 Copay
Urgent Care $35 Copay $25 Copay $35 Copay
Emergency Care $120 Copay $120 Copay $120 Copay
Lab Services 0% Co-insurance 0% Co-insurance 0% Co-insurance
Home Health Care 100% Coverage 100% Coverage 100% Coverage
Chiropractic Care $20 Copay $15 Copay $20 Copay
Inpatient Hospital Care $265 Per Day for Days 1-7,
$0 Per Day for Day 8 and beyond
$195 Per Day for Days 1-9,
$0 Per Day for Day 10 and beyond
$350 Per Day for Days 1-7,
$0 Per Day for Day 8 and beyond
Outpatient Surgery at Hospital $250 Copay $150 Copay $250 Copay
Outpatient Surgery at Ambulatory Surgery Center $175 Copay $100 Copay $175 Copay
Part D Drug Coverage
  Preferred Pharmacies Other Network Pharmacies Preferred Pharmacies Other Network Pharmacies Preferred Pharmacies Other Network Pharmacies
Annual Deductible $0 $0 $0 $0 $0 $0
Tier 1 – Preferred Generic $0 Copay $4 Copay $0 Copay $4 Copay $0 Copay $4 Copay
Tier 2 – Generics $0 Copay $12 Copay $0 Copay $12 Copay $0 Copay $12 Copay
Tier 3 – Preferred Brands $39 Copay $47 Copay $34 Copay $42 Copay $39 Copay $47 Copay
Tier 4 – Non-Preferred Brands $75 Copay $100 Copay $65 Copay $80 Copay $75 Copay $100 Copay
Tier 5 – Specialty Drugs 33% Co-insurance 33% Co-insurance 33% Co-insurance 33% Co-insurance 33% Co-insurance 33% Co-insurance
Tier 6 – Insulins $0 Copay $0 Copay $0 Copay $0 Copay N/A N/A
Initial Coverage Limits $4,020 Per Year $4,020 Per Year $4,020 Per Year $4,020 Per Year $4,020 Per Year $4,020 Per Year
Extra Benefits
Vision Care $35 Copay for routine eye exam
$0 Copay for a pair of eyeglass frames
$35 Copay for routine eye exam
$0 Copay for a pair of eyeglass frames
$35 Copay for routine eye exam
$0 Copay for a pair of eyeglass frames
Preventive Dental Care $35 Copay $35 Copay $0 Copay
Comprehensive Dental Care No Coverage No Coverage $100 Deductible
$1,000 Maximum Benefit Per Year
Over-the-Counter (OTC) Items $100 Per Quarter $100 Per Quarter $100 Per Quarter
Hearing $1,000 allowance for up to 2 hearing aids every 2 years (both ears combined) $1,000 allowance for up to 2 hearing aids every 2 years (both ears combined) $20 Copay for hearing exam
Transportation Assistance $0 Copay for 24 one-way trips to approved locations per year $0 Copay for 24 one-way trips to approved locations per year $0 Copay for 24 one-way trips to approved locations per year
SilverSneakers Included at no additional cost Included at no additional cost Included at no additional cost
Travel Benefits Emergency or urgent care coverage if you are making a trip out of state or country Emergency or urgent care coverage if you are making a trip out of state or country Emergency or urgent care coverage if you are making a trip out of state or country
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*At preferred pharmacies. Schnucks, Target, CVS and Pharmax are our preferred pharmacy providers. Other pharmacies are available in the Essence network.

Essence Advantage® (HMO)
  Essence Advantage® (HMO)
Hospital & Medical Coverage
Monthly Premium $0
Maximum Out-of-Pocket Limit $1,900 Per Year
Annual Deductible $0
Preventive Care/Screenings $0 Copay
Primary Care Physician Visits $0 Copay
Specialist Doctor Visits $35 Copay
Urgent Care $35 Copay
Emergency Care $120 Copay
Lab Services 0% Co-insurance
Home Health Care 100% Coverage
Chiropractic Care $20 Copay
Inpatient Hospital Care $265 Per Day for Days 1-7,
$0 Per Day for Day 8 and beyond
Outpatient Surgery at Hospital $250 Copay
Outpatient Surgery at Ambulatory Surgery Center $175 Copay
Part D Drug Coverage
  Preferred Pharmacies Other Network Pharmacies
Annual Deductible $0 $0
Tier 1 – Preferred Generic $0 Copay $4 Copay
Tier 2 – Generics $0 Copay $12 Copay
Tier 3 – Preferred Brands $39 Copay $47 Copay
Tier 4 – Non-Preferred Brands $75 Copay $100 Copay
Tier 5 – Specialty Drugs 33% Co-insurance 33% Co-insurance
Tier 6 – Insulins $0 Copay $0 Copay
Initial Coverage Limits $4,020 Per Year $4,020 Per Year
Extra Benefits
Vision Care $35 Copay for routine eye exam
$0 Copay for a pair of eyeglass frames
Preventive Dental Care $35 Copay
Comprehensive Dental Care No Coverage
Over-the-Counter (OTC) Items $100 Per Quarter
Hearing $1000 allowance for up to 2 hearing aids every 2 years (both ears combined)
Transportation Assistance $0 Copay for 24 one-way trips to approved locations per year
SilverSneakers Included at no additional cost
Travel Benefits Emergency or urgent care coverage if you are making a trip our of state or country
  View All Plan Benefits
Essence Advantage Plus® (HMO)
  Essence Advantage Plus® (HMO)
Hospital & Medical Coverage
Monthly Premium $73
Maximum Out-of-Pocket Limit $1,700 Per Year
Annual Deductible $0
Preventive Care/Screenings $0 Copay
Primary Care Physician Visits $0 Copay
Specialist Doctor Visits $30 Copay
Urgent Care $25 Copay
Emergency Care $120 Copay
Lab Services 0% Co-insurance
Home Health Care 100% Coverage
Chiropractic Care $15 Copay
Inpatient Hospital Care $195 Per Day for Days 1-9,
$0 Per Day for Day 10 and beyond
Outpatient Surgery at Hospital $150 Copay
Outpatient Surgery at Ambulatory Surgery Center $100 Copay
Part D Drug Coverage
  Preferred Pharmacies Other Network Pharmacies
Annual Deductible $0 $0
Tier 1 – Preferred Generic $0 Copay $4 Copay
Tier 2 – Generics $0 Copay $12 Copay
Tier 3 – Preferred Brands $34 Copay $42 Copay
Tier 4 – Non-Preferred Brands $65 Copay $80 Copay
Tier 5 – Specialty Drugs 33% Co-insurance 33% Co-insurance
Tier 6 – Insulins $0 Copay $0 Copay
Initial Coverage Limits $4,020 Per Year $4,020 Per Year
Extra Benefits
Vision Care $35 Copay for routine eye exam
$0 Copay for a pair of eyeglass frames
Preventive Dental Care $35 Copay
Comprehensive Dental Care No Coverage
Over-the-Counter (OTC) Items $100 Per Quarter
Hearing $1000 allowance for up to 2 hearing aids every 2 years (both ears combined)
Transportation Assistance $0 Copay for 24 one-way trips to approved locations per year
SilverSneakers Included at no additional cost
Travel Benefits Emergency or urgent care coverage if you are making a trip our of state or country
  View All Plan Benefits
Essence Advantage Select (HMO)
  Essence Advantage Select (HMO)
Hospital & Medical Coverage
Monthly Premium $0
Maximum Out-of-Pocket Limit $2,900 Per Year
Annual Deductible $0
Preventive Care/Screenings $0 Copay
Primary Care Physician Visits $0 Copay
Specialist Doctor Visits $45 Copay
Urgent Care $35 Copay
Emergency Care $120 Copay
Lab Services 0% Co-insurance
Home Health Care 100% Coverage
Chiropractic Care $15 Copay
Inpatient Hospital Care $350 Per Day for Days 1-7,
$0 Per Day for Days 8 and beyond
Outpatient Surgery at Hospital $250 Copay
Outpatient Surgery at Ambulatory Surgery Center $175 Copay
Part D Drug Coverage
  Preferred Pharmacies Other Network Pharmacies
Annual Deductible $0 $0
Tier 1 – Preferred Generic $0 Copay $4 Copay
Tier 2 – Generics $0 Copay $12 Copay
Tier 3 – Preferred Brands $39 Copay $47 Copay
Tier 4 – Non-Preferred Brands $75 Copay $100 Copay
Tier 5 – Specialty Drugs 33% Co-insurance 33% Co-insurance
Initial Coverage Limits $3,820 Per Year $3,820 Per Year
Extra Benefits
Vision Care $35 Copay for routine eye exam
$0 Copay for a pair of eyeglass frames
Preventive Dental Care $0 Copay
Comprehensive Dental Care $100 Deductible
$1,000 Maximum Benefit Per Year
Over-the-Counter (OTC) Items $100 Per Quarter
Hearing $20 Copay for hearing exam
Transportation Assistance $0 Copay for 24 one-way trips to approved locations per year
SilverSneakers Included at no additional cost
Travel Benefits Emergency or urgent care coverage if you are making a trip our of state or country
  View All Plan Benefits