2026 Plan Changes Explained
Find answers to our most asked questions
See the topics below to gain a better understanding of Essence benefits and any plan changes we've made for 2026. If you need more clarification, don't hesitate to contact us. Our goal is to get you the information you need to feel confident in your health plan.
In 2025 our Essence Advantage Select (HMO) plan members (St. Louis area) had a built-in allowance for comprehensive dental services. For 2026 we’ll transition from built-in comprehensive dental coverage to a Flex Card allowance, which can be used for dental, vision and hearing (including comprehensive dental services like implants). The Flex Card comes preloaded with your entire annual allowance, you can use it with both in- and out-of-network providers. This change will give you more flexibility to choose how to use your supplemental benefits. For 2026 this plan is available in the St. Louis area and Mid Missouri.
All Essence members that have a plan with a Flex Card can use the allowance for preventive and comprehensive dental services in 2026. For more information on your plan’s dental benefit, see Chapter 4 of your Evidence of Coverage booklet. You can also talk to a benefit specialist by calling 1-877-644-2319 (TTY: 711).
HMO Plans
Preventive dental coverage, including exams, X-rays and fluoride treatments come standard with our HMO plans. Additional preventive and comprehensive dental services are covered via the Flex Card.
PPO Plans
If your plan includes a Flex Card, use it for preventive and comprehensive dental services, such as fillings, extractions, root canals and more.
We’re excited to partner with LIBERTY Dental Plan to administer your dental benefit, giving you a larger, easy-to-access network of providers to care for all your dental needs. Founded in 2002 they offer a wide network of general and specialty dentists across the U.S.
Essence and LIBERTY understand the importance of dental health. We’re committed to providing options for your complete health protection.
Preventive dental coverage, including exams, X-rays and fluoride treatments come standard with our HMO plans.
All Essence members that have a plan with a Flex Card can use the allowance for preventive and comprehensive dental services in 2026.
To find an in-network LIBERTY provider, visit LibertyDentalPlan.com/Find-a-Dentist or contact LIBERTY Dental at 1-866-609-0822 (TTY: 1-877-855-8039).
For 2026, a number of our plans across markets cover over-the-counter (OTC) items. If your plan had an OTC benefit in 2025, that coverage continues for 2026. We also added the OTC benefit on two plans in the Chicago market for 2026.
Need OTC? We Have Options
To find Essence plans in your area with OTC coverage, reach out to a benefit specialist at 1-866-509-5398 (TTY: 711) or use the search tool on our website.
Some of our plan members may notice higher maximum out-of-pocket limits (the most you’re required to pay for healthcare in a given plan year). Let us start by saying that the decision to make that increase wasn’t an easy one. We want all our members to get the care they need, and we understand it depends largely on how much things cost.
Rising healthcare costs worldwide and healthcare regulations contribute to the adjustments made to plans each year. Factors such as rising medical procedure expenses, increasing prescription prices, advancements in healthcare technology and the Inflation Reduction Act of 2022 contribute to the overall increase in healthcare expenses. This act addresses rising prescription drug costs and helps make medications affordable for all Medicare beneficiaries (learn more about how you’ll benefit from this new policy).
We have to strike a delicate balance between providing comprehensive coverage and managing increasing costs that are out of our control. The adjustments are sometimes necessary to continue offering you the benefits you need—like dental, vision and hearing, $0 copays for in-network primary care visits and other low costs for important services. Every health plan faces these challenges, but what we can promise you is that we work tirelessly to make sure you have what you need to get healthy and stay that way. We will continue to do everything possible to keep your costs manageable while providing the excellent care and quality you deserve in your health plan.
We’re excited to partner with Uber to provide a new solution for getting to medical appointments and the pharmacy in the St. Louis and Louisville/Lexington markets.
In 2026, the Essence Advantage (HMO) and Essence Advantage Plus (HMO) plans in those markets include transportation service. You can request rides by phone or by using the Uber app to request and track your driver in real time. Uber app scheduling is subject to availability. To learn more about using your transportation benefit, call our customer service team at 1-866-597-9560 (TTY: 711) or sign in to your Member Website.
We're Here to Help
Although the transportation benefit is not available on all plans, we’re still committed to assisting our members with finding resources for their transportation needs. United Way’s Ride United program is a good place to start. Visit UnitedWay.org/Ride-United/Ride-United-Transportation-Access or call 211 to get assistance with transportation services in your area.
If you need more help, our customer service team can provide information, recommendations and support for locating transportation services.
In order to better align with member needs and regulatory updates, we made the decision to retire certain plans and transition members of those plans to ones with similar benefits, network access and drug coverage. There may be differences in specifics such as premiums, copays or coverage, so every member is encouraged to review the plan changes that are sent out each year explaining the details. This is called the Annual Notice of Change (ANOC).
For some of our members transitioning to a new plan, you may notice that you have a new member ID number. Make your transition smoother by reviewing the Plan Change page on the Essence Member Website.
You Have Options
If you have questions about your new plan or want to explore other Essence plan options, we’re happy to help you. Call 1-877-644-2319 to talk to a licensed advisor about your healthcare needs.
The Inflation Reduction Act of 2022 (IRA) addresses rising prescription drug costs and helps make medications affordable for all Medicare beneficiaries. The Act introduces certain cost-sharing measures, such as the Part D deductible, to help control healthcare inflation and the impact on your prescription drug expenses.
As a result of the IRA, individuals with Medicare Part D no longer face the burden of the 'donut hole' or coverage gap. This means you won't encounter an increase in your out-of-pocket costs for prescription drugs once you reach the initial coverage limit. This more predictable benefit structure ensures your annual out-of-pocket spending on covered Part D drugs is capped at $2,100 in 2026. Once you reach this limit, you will enter the catastrophic phase of coverage and you will pay nothing for Part D eligible drugs the rest of the year.
Here's a breakdown of how your Part D coverage works and what you can expect in your 2026 Essence plan.
*$0 Copay applicable at participating preferred or mail-order pharmacies.
You must meet your Part D deductible (if applicable) before standard cost-sharing will apply.
Changes for 2026
If your 2025 plan had a Part D deductible for brand-name and specialty drugs (tiers 3-5), you’ll notice an increase for 2026. If a Part D deductible is included in your plan, you must pay that amount before your standard copays or coinsurance for those drugs will apply. The deductible will apply to any tier 3-5 drugs regardless of the pharmacy you choose.
How We’re Helping You Save
- Sign up for our mail order service with Express Scripts® to get a 90-day supply of your prescriptions for the cost of two months. Visit the “Pharmacy” section of your Member Website for a direct link to the Express Scripts member portal or call them at 1-800-282-2881 (TTY: 1-800-759-1089).
- We’ve maintained $0 copays for tier 1 generic drugs at preferred and mail order pharmacies. To find a complete list of preferred pharmacies use the Provider Directory on your Member Website. The Prescription Drug Formulary is also available on the site.
We understand that managing medication expenses is important. If you're a current member with any further questions or concerns, please don't hesitate to reach out to our customer service team at 1-866-597-9560 (TTY: 711). You can also email customer service at customerservice@essencehealthcare.com.
Yes, St. Luke’s Hospital remains in our network. To find providers in our network, visit our online search tool.
Essence believes in helping your health and preventing issues before they start. That’s why we’ve expanded our partnership with Oura to offer Oura Ring on more plans.
Oura Ring is a smart, comfortable wearable that turns complex health data into more than 50 easy-to-understand insights. With the Oura App, it becomes a personal wellness guide, right at your fingertips. Essence is the only Medicare Advantage plan offering this life-changing wearable. Share your Oura Ring data with your doctor for more proactive, productive visits.
Members with this benefit can order Oura Ring free of charge and get free access to the Oura App. Your Oura Ring syncs with the Oura App to track your heart health, activity, temperature trends, sleep patterns, average blood oxygen, stress indicators and more.
New for 2026! More colors and finishes available.
If you’re an Essence member with this benefit in 2026, visit your Member Website and click on “Oura Ring” for more information, including instructions on how to order your sizing kit. Once you’ve received your kit and you identify the correct size, you can order your Oura Ring using the link on your sizing kit.
To learn more about Oura Ring, visit our Oura benefits page.
Essence covers all the hospital and medical services included with Original Medicare-plus prescription drugs and extras like dental, vision and more—for as low as a $0 monthly premium. And when you compare Essence plans with competitors, you'll find we have affordable inpatient hospital copays. Our plans don’t have a medical or hospital deductible—we start covering you on day one.
We work hard to make sure that the costs for services don't prevent our members from getting the care they need. We cover many services for low to no copay at all (in-network primary care visits and lab services, preferred generic drugs and more). Most plans even come with a preloaded Flexible Benefits Card to spend on extra benefits as you see fit.
While we can't guarantee that our costs are the lowest, we can promise that the care and service you'll receive are top-notch. Essence is consistently highly rated by the Centers for Medicare & Medicaid Services, and those ratings are based on things like member satisfaction, how we keep you healthy, and our benefits and costs. We invite you to shop our plans and see the many great benefits and savings they can offer you. You can also speak to a benefit specialist by calling 1-866-509-5398 (TTY: 711).
Note that benefits and amounts differ by plan and market.
Our customer service team is highly trained, based in the U.S. and ready to help with enrollment, benefit questions, claims information, finding a provider and more. During certain times of the year, such as the Annual Enrollment Period, wait times may be higher than normal due to increased demand. If you need help faster, we recommend emailing us with your contact information and preferred method of contact, along with what you'd like to discuss. We appreciate your patience and understanding during these busy times.
The Essence Member Website: Plan Information and More—at Your Fingertips
If you're an Essence member, you can find answers to many questions by signing in to your Member Website. It’s your hub for benefit and claims information, provider and prescription search tools, billing options, important plan documents and more.
How to Reach Us
Our benefit specialists and customer service team are available from 8 a.m. to 8 p.m., seven days a week. You may reach a messaging service on weekends from April 1 to September 30 and holidays. Please leave a message, and your call will be returned the next business day.
Members with 2026 Benefit Questions
Speak to a benefit specialist by calling 1-877-644-2319 (TTY: 711), or email customerservice@essencehealthcare.com.
Member Questions About Current Benefits, Claims, Providers and Billing
Speak to a customer service team member by calling 1-866-597-9560 (TTY: 711), or email customerservice@essencehealthcare.com.
Non-Members with Questions About Essence Plans
Speak to a benefit specialist by calling 1-866-509-5398 (TTY: 711).
If your Flex Card expiration date is coming up, you’ll get a new card in the mail around the time of expiration.
If you transitioned to a new plan because your plan was retired, and your member ID number changed, you'll automatically get a new Flex Card.
For questions, please contact customer service at 1-866-597-9560 (TTY: 711).
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