Essence Advantage (HMO)

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We’ve got you covered from head to toe

$0 Premium and NO Deductibles

With Essence Advantage, there are no additional premiums to pay. There are also no annoying deductibles to meet. Your coverage begins right away.

Complete Coverage With One Plan From One Company

Unlike Original Medicare plans, Essence Advantage bundles your medical, hospital and prescription drug coverage together in one comprehensive plan.

The plan comes with valuable extra benefits that save you even more.

$0 Copays on Generic Prescriptions

Save even more money on your prescription drugs when you fill your prescription at preferred pharmacies. Essence Healthcare members can get generic prescriptions for $0 copays and reduced copays on brand-name medications at any participating preferred pharmacy.

Important Financial Protection

Essence Healthcare protects your savings and retirement by putting an annual limit on what you have to pay out of your own pocket for your covered medical expenses — important protection not offered by Original Medicare plans.

Important Travel Coverage

Whether you are making a trip out of the state or out of the country, we have you covered. If you ever get sick or injured when away from home, you can rest easy knowing you have emergency or urgent-care coverage.

Benefits at a Glance

Hospital and Medical Coverage

Essence Advantage (HMO)

Monthly Premium

Monthly Premium — $0

Maximum Out-of-Pocket Limit

Maximum Out-of-Pocket Limit — $3,000 Per Year

Annual Deductible

Annual Deductible — $0

Preventive Care/Screenings

Preventive Care/Screenings — $0 Copay

Primary Care Physician Visits

Primary Care Physician Visits — $10 Copay

Specialist Doctor Visits

Specialist Doctor Visits — $40 Copay

Urgent Care

Urgent Care — $30 Copay

Emergency Care

Emergency Care — $125 Copay

Lab Services

Lab Services — $20 Copay

Home Health Care

Home Health Care — 100% Coverage

Chiropractic Care

Chiropractic Care — $20 Copay per visit

Inpatient Hospital Care

Inpatient Hospital Care — $310 Per Day for Days 1-7, $0 Per Day for Days 8 and Beyond

Outpatient Surgery at Hospital

Outpatient Surgery at Hospital — $250 Copay

Outpatient Surgery at Ambulatory Surgery Center

Outpatient Surgery at Ambulatory Surgery Center — $175 Copay

Part D Drug Coverage

Each Essence plan also includes generous prescription drug coverage. While we offer low copays
at all participating pharmacies, you also have the option of saving even more if you get your
prescriptions filled at a preferred pharmacy.

Essence Advantage (HMO)

Annual Deductible

Annual Deductible — $0

Tier 1 – Preferred Generics

Tier 1 – Preferred Generics — $0 Copay*

Tier 1 – Preferred Generics — $7 Copay*

Tier 2 – Generics

Select Insulins†

Tier 2 – Generics — $0 Copay*

Tier 2 – Generics — $12 Copay*

Select Insulins —

Tier 3 – Preferred Brands

Select Insulins†

Tier 3 – Preferred Brands — $42 Copay*

Tier 3 – Preferred Brands — $47 Copay*

Select Insulins —

Tier 4 – Non-Preferred Brands

Tier 4 – Non-Preferred Brands — $85 Copay*

Tier 4 – Non-Preferred Brands — $95 Copay*

Tier 5 – Specialty Drugs

Tier 5 – Specialty Drugs — 33% Coinsurance*

Tier 6 – Insulins

Tier 6 – Insulins — $0 Copay*

Initial Coverage Limits

Initial Coverage Limits — $4,660 Per Year

*30-Day supply.

Drug Price Search Tool

Pharmacy Search Tool

Insulin Coverage

Important—you won’t pay more than $35 for a one-month supply of each Part D insulin product covered by our plan, no matter the cost-sharing tier of the insulin product, the prescription drug coverage stage you are in (initial coverage, coverage gap or catastrophic coverage) or your Extra Help status.

$0 Copays for Tier 6 insulins during the Initial Coverage Stage.

Excludes insulins delivered through a pump, which are covered under Part B for 20% coinsurance.

Extra Benefits

In addition to comprehensive medical, hospital and Part D prescription drug coverage, Essence plans also include many valuable extras not offered by Original Medicare or Medicare supplements at no additional cost to you — just another way of helping you stay healthy while saving you money.

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