2027 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 2027. 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.
Some of our PPO plan members will notice cost-share changes for services in 2027. PPO plans give members the flexibility to see both in- and out-of-network providers. That flexibility is valuable, but it also means costs can be less predictable to manage on our end, and adjustments like these are sometimes necessary so we can keep offering the comprehensive benefits our members count on.
HMO plans offer more predictability.
If predictable costs are a priority for you, our HMO plans are built with that in mind. Most services come with a flat, predictable copay. Costs also tend to run lower overall, thanks to the close relationships we build with our in-network providers.
By working closely with a dedicated network of providers, we're able to keep costs down while helping ensure the care you receive is coordinated and consistent. We also invest directly in supporting our in-network providers—giving them the tools and resources they need to spend more time with members and deliver better, more personalized care.
We're here to help.
If you have questions about your plan's costs for 2027 or want to explore whether an HMO plan might be a better fit for you, call 1-877-644-2319 (TTY: 711) to speak with a benefit specialist.
Yes! We're excited to welcome Washington Regional, which includes local providers of the Health Partners network, to our provider network in Northwest Arkansas for 2027.
This expansion gives Essence members in the area even more in-network options for hospital and physician care, making it easier to get the care you need close to home.
To find providers in our network, visit our online search tool.
We offer plans in a variety of services areas, but our HMO plans may be more widely available than our PPO plan options. See the lists below for the types of plans we offer in each area.
Southwest Missouri and Northwest Arkansas
Our service area for all plans (HMO and PPO): the Missouri counties of Barry, Christian, Dallas, Greene, Lawrence, Polk, Stone, Taney, and Webster, and the Arkansas counties of Benton, Carroll, Madison, and Washington.
Our HMO plan is also available in Barton, Cedar, and Dade counties in Missouri, and Crawford, Franklin, Johnson, Logan, Newton, Scott, and Sebastian counties in Arkansas. Our PPO plan is not offered in these additional counties.
Greater St. Louis Area
Our service area for all plans (HMO and PPO): St. Louis City; the Missouri counties of Crawford, Franklin, Gasconade, Jefferson, Lincoln, Montgomery, St. Charles, St. Louis, Warren, and Washington; and the Illinois counties of Bond, Clinton, Jersey, Macoupin, Madison, Monroe, and St. Clair.
Our HMO plans are also available in Calhoun, Montgomery, and Washington counties in Illinois. PPO plans are not offered in these additional counties.
Missouri
Our service area includes Boone and Callaway counties. We offer both HMO and PPO plan options in these counties.
One HMO plan option is also available in Chariton, Maries, Miller, Morgan, Osage, Randolph, and Reynolds counties in Missouri. PPO plans are not offered in these additional counties.
Greater Chicago Area
Our service area for all plans (HMO and PPO): the Illinois counties of Cook, DuPage, and Will.
Our HMO plan is also available in Kane and Kendall counties in Illinois. PPO plans are not offered in these additional counties.
Central Arkansas
Our service area includes the Arkansas counties of Conway, Grant, Lonoke, Perry, Prairie, and Pulaski. We offer both HMO and PPO plan options in these areas.
Greater Louisville and Lexington Areas
Our service area includes the Kentucky counties of Anderson, Bourbon, Bullitt, Carroll, Clark, Fayette, Harrison, Henry, Jefferson, Larue, Meade, Mercer, Nelson, Oldham, Owen, Robertson, Shelby, Spencer, Trimble, Washington, and Woodford, and the Indiana counties of Clark, Crawford, Floyd, Harrison, Jefferson, Ripley, Scott, Switzerland, and Washington. We offer both HMO and PPO plan options in these areas.
We're happy to share that 98 percent of our drugs will be covered in the same way or better than in 2026. One notable change for 2027 involves how insulin is covered for HMO plan members.
In 2026, Essence HMO plans had a tier 6 in their drug formulary, which included $0 insulins. For 2027, tier 6 has been removed, and insulins are now covered under tiers 1 through 5 instead.
Because of the Inflation Reduction Act, HMO and PPO plan members won't pay more than $35 for a one-month supply of each insulin product covered by our plans during the initial coverage phase. In the catastrophic phase, members will pay $0 for all covered Part D drugs.
The Inflation Reduction Act of 2022 addresses rising prescription drug costs and helps make medications affordable for all Medicare beneficiaries (learn more about how you’ll benefit from this policy).
With Essence, you have access to a variety of plans designed to fit your budget. Our HMO plans feature no medical deductibles, meaning your medical coverage begins with the first dollar you spend, and you’ll pay the cost outlined in your Evidence of Coverage and/or Summary Benefits. Some HMO plans do require you to meet a pharmacy deductible, which means you’ll pay the full cost of drugs on certain tiers until you reach your deductible amount. After you reach that amount, your standard cost-sharing, as outlined in your plan documents, will apply.
To provide more flexibility in benefits, some of our PPO plans will include a medical deductible in 2027. PPO plans will also have pharmacy deductibles. Once those amounts are met, your standard copays or coinsurance will apply.
To continue providing the comprehensive benefits you need and the low copays you deserve, we've had to make some changes to the Flex Card. Starting on Jan. 1, 2027:
- Some PPO plans will see lower allowances.
- HMO plan allowances will stay the same or increase.
- Some plans may also see changes in Flex-Card-covered services.
Changes to Flex-Card-Covered Services
- Medical copay coverage: The Flex Card will no longer be eligible for use on medical copays. This change applies to all Flex Cards in all our service areas.
- Vision and hearing coverage: Essence Advantage® Choice (PPO) plan members in the Louisville and Lexington areas will no longer be able to use their Flex Card to purchase hearing aids and eyewear. The Flex Card can be used to purchase non‑Medicare‑covered dental products and services, as well as routine vision and hearing exams, plus hearing aid fittings.
Essence works with a large network of preferred pharmacies, and for 2027, we've expanded that network even further. Filling your prescriptions at one of these locations helps you save money on your medications.
Other preferred and standard retail pharmacies are available in our network. To find pharmacies near you, use our online search tool.(opens in
Essence offers both inpatient and outpatient mental health services, including individual and group therapy or substance abuse sessions. Mental healthcare is also available 24 hours a day, seven days a week.
Call 1-877-405-7612 if you're experiencing any of the following persistent symptoms:
- Depression, sadness, hopelessness, loss of interest, weeping, sleeplessness, or loss of appetite
- Anxiety, panic attacks, disabling fears, obsessions, compulsions, or overwhelming stress
- Eating disorders such as anorexia or bulimia
- Issues related to alcohol or drugs
- Inability to cope with life and fulfill your responsibilities
The Essence Behavioral Health team offers confidential evaluations to help guide you to the right physicians, support groups, or other helpful resources. You don't need a referral to access these services.
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 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 solution for getting to medical appointments and the pharmacy in the St. Louis and Louisville/Lexington markets.
In 2027, 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 Portal.
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.
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 $2,400 in 2027. 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 2027 Essence plan.
*$0 Copay applicable at participating preferred or mail-order pharmacies.
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. A deductible is not required for tier 1-2 drugs. If you're an Essence Advantage Select® member in Chicago, you also won't have a deductible for tier 3.
How We’re Helping You Save
- Sign up for our mail-order service with Express Scripts® to get a 90-day supply of many prescriptions for the cost of two months.* Visit the “Prescription Drugs” section of your Member Portal for a direct link to the Express Scripts Portal or call them at 1-800-987-4918 (TTY: 1-800-899-2114).
*Does not apply to drug tiers with a coinsurance. - We’ve maintained $0 copays for tier 1 preferred generic drugs at preferred and mail order pharmacies. To find a complete list of preferred pharmacies use the Provider Directory on your Member Portal. 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.
What's Changing for 2027?
As we continue to evaluate our benefits each year, we've made the decision to discontinue the Oura Ring benefit on many of our plans for 2027.
Why the Change
We’re focused on making sure the benefits we offer are ones that work well for the widest range of our members. After careful review, we found that dedicating our resources to benefits with broader, more consistent value across our entire membership—like fitness and wellness access—allows us to better serve our members as a whole.
All Essence members have a free SilverSneakers® fitness membership, giving you access to thousands of gyms and fitness locations nationwide, along with online classes and community events designed to help you stay active, connected, and healthy.
If you're an Essence member, visit your Member Portal for more information on how to activate your membership and find participating locations near you.
If You Currently Have Oura Ring
If your plan included Oura Ring in 2026 and this benefit is no longer part of your 2027 plan, you're welcome to keep and continue using your ring. We just won't be able to provide the free Oura App Membership in 2027.
If you have questions about continuing your Oura App Membership, please email partnersupport@ouraring.com.
Want to Learn More About Oura Ring?
Current members: The Member Portal is your best resource for all things Oura Ring.
Non-members: 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. We also offer plan options with no medical deductibles.
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 Portal and App: 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 Portal. It’s your hub for benefit and claims information, provider and prescription search tools, billing options, important plan documents, and more. We're also excited to announce that the MyEssence™ mobile app will be live in 2027—giving you access to all things Essence, in the palm of your hand.
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 2027 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 your member ID number is changing, 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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