Essence Advantage Plus (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 Plus 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.

 

Medical & Hospital Coverage

Your Essence Healthcare plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments.

Essence Advantage Plus (HMO)
Monthly Premium $79
Annual Medical Deductible $0 Per Year
Preventative Care/Screenings $0 Copay
Primary Care Physician Visits $5 Copay
Specialty Care Physician Visits $30 Copay
Labs 0% Co-insurance
Home Health Care 100% Copay
Chiropractic Services $15 Copay
Urgent Care $25 Copay
Emergency Care $100 Copay
Inpatient Hospital Care $195 Copay Per Day for Days 1-9,
$0 Per Day for Days 10-90,
$0 Copay for additional days
Maximum Out-of-Pocket Limit  What’s This? $2,300 Per Year

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 Plus (HMO)
Preferred
Pharmacies
Other Network
Pharmacies
Annual Part D Deductible $0 Per Year $0 Per Year
Preferred Generics $0 Copay $4 Copay
Generics $0 Copay $12 Copay
Preferred Brand $34 Copay $42 Copay
Non-Preferred Brands $65 Copay $80 Copay
Specialty Drugs 33% Co-insurance 33% Co-insurance
Initial Coverage Limit $3,750 Per Year $3,750 Per Year

Part D drug 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 offers many valuable extras not offered by Original Medicare or Medicare supplement plans–at no additional cost to you.

Essence Advantage Plus (HMO)
Routine Eye Exam $35 Copay
Eyeglass Frames or Contacts $35 Copay
Preventive Dental Visits $35 Copay
Transportation Assistance 20 one-way trips per year
SilverSneakers® Fitness Benefits Included at No Additional Cost
Travel Coverage Urgent and emergent care is available worldwide

Our eyewear benefit is limited to one pair of eyeglass lenses and frames per year. Extra benefit expenses are not covered under the maximum out-of-pocket limit.

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