Cincinnati/Northern Kentucky Area Medicare Advantage Plans

Go back to the 2024 Essence Healthcare plan-year website

Hospital & Medical Coverage
Maximum out of pocket
Annual deductible
Preventative care/screening
Primary care physician visits
Specialist doctor visits
Urgent care
Emergency care
Lab services
Home health visit
Chiropractic care
Inpatient hospital care
Outpatient surgery at hospital
Outpatient surgery at ambulatory surgery center

Drug Coverage
Preferred pharmacies*
Other network pharmacies*
Preferred pharmacies*
Other network pharmacies*
Annual deductible
Tier 1 – Preferred Generic
Tier 2 – Generics
Tier 3 – Preferred Brands
Tier 4 – Non-Preferred Brands
Tier 5 – Specialty Drugs
Initial Coverage Limits

Extra Benefits

Essence Advantage Choice (PPO) Plan Details

$0
Monthly Premium
$0
Primary Doctor
Copay
$0
Annual Deductible

Essence Advantage (HMO) Plan Details

$0
Monthly Premium
$0
Primary Doctor
Copay
$0
Annual Deductible

Hospital & Medical Coverage

Maximum out of pocket $3,900 Per year in-network
$5,900 Per year in-network and out-of-network (combined)
Annual deductible $0
Preventative care/screening $0 Copay
Primary care physician visits $0 Copay in-network
$15 Copay out-of-network
Specialist doctor visits $30 Copay in-network
$30 Copay out-of-network
Urgent care $45 Copay
Emergency care $110 Copay
Lab services $5 Copay in-network
40% Coinsurance out-of-network
Home health visit $0 Copay in-network
40% Coinsurance out-of-network
Chiropractic care $20 Copay in-network
$20 Copay out-of-network
Inpatient hospital care $375 Copay per day for days 1-5, $0 Copay per day for days 6 and beyond in-network
$375 Copay per day for days 1-5, $0 Copay per day for days 6 and beyond out-of-network
Outpatient surgery at hospital $325 Copay in-network
$325 Copay out-of-network
Outpatient surgery at ambulatory surgery center $285 Copay in-network
$285 Copay out-of-network
Maximum out of pocket $3,650 Per year
Annual deductible $0
Preventative care/screening $0 Copay
Primary care physician visits $0 Copay
Specialist doctor visits $30 Copay
Urgent care $30 Copay
Emergency care $110 Copay
Lab services $5 Copay
Home health visit $0 Copay
Chiropractic care $20 Copay per visit
Inpatient hospital care $295 Copay per day for days 1-5, $0 Copay per day for days 6 and beyond
Outpatient surgery at hospital $285 Copay
Outpatient surgery at ambulatory surgery center $245 Copay

Drug Coverage

  Preferred Pharmacies* Other Network Pharmacies*
Annual deductible $0 $0
Tier 1 – Preferred Generics** (also through the coverage gap) $0 Copay* $4 Copay*
Tier 2 – Generics** (also through the coverage gap) $0 Copay* $12 Copay*
Tier 3 – Preferred Brands $45 Copay* $47 Copay*
Tier 4 – Non-Preferred Brands $95 Copay* $100 Copay*
Tier 5 – Specialty Drugs 33% Coinsurance* 33% Coinsurance*
Initial Coverage Limits $5,030 Per Year $5,030 Per Year

*30-Day supply.
**During the coverage gap, for tiers 1 and 2, you’ll pay the same as during the initial coverage phase, or 25% of the drug cost (whichever is lower).
Initial Coverage Limit: Once your total drug costs reach $5,030, you move to the coverage gap phase.
Catastrophic coverage: After your yearly out-of-pocket drug costs reach $8,000, you pay $0 for all plan-covered drugs.
Insulin coverage: You won’t pay more than $35 for a one-month supply of each covered insulin product regardless of the cost-sharing tier.
  Preferred Pharmacies* Other Network Pharmacies*
Annual deductible $0 $0
Tier 1 – Preferred Generics** (also through the coverage gap) $0 Copay* $5 Copay*
Tier 2 – Generics** (also through the coverage gap) $0 Copay* $10 Copay*
Tier 3 – Preferred Brands $40 Copay* $47 Copay*
Tier 4 – Non-Preferred Brands $95 Copay* $100 Copay*
Tier 5 – Specialty Drugs 33% Coinsurance* 33% Coinsurance*
Initial Coverage Limits $5,030 Per Year $5,030 Per Year

*30-Day supply.
**During the coverage gap, for tiers 1 and 2, you’ll pay the same as during the initial coverage phase, or 25% of the drug cost (whichever is lower).
Initial Coverage Limit: Once your total drug costs reach $5,030, you move to the coverage gap phase.
Catastrophic coverage: After your yearly out-of-pocket drug costs reach $8,000, you pay $0 for all plan-covered drugs.
Insulin coverage: You won’t pay more than $35 for a one-month supply of each covered insulin product regardless of the cost-sharing tier.

Prescriptions

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Drug Costs

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Extra Benefits

Flexible Benefits Card $500 Allowance for OTC items, non-Medicare covered dental, vision and hearing
Applied quarterly in $125 increments
The Flexible Benefits Card is not a credit card, cannot be converted to cash, cannot be used to pay plan premiums, and cannot be used to pay for non-covered Flexible Benefit card services.
Vision Care $0 Copay for routine eye exam in-network/$0 Copay for routine eye exam out-of-network
$0 Copay for eyewear in-network
$200 Allowance for eyewear every calendar year (combined in- and out-of-network)
See Flexible Benefits Card section for information on an additional allowance.
Preventive Dental Care $0 Copay in-network/$0 Copay out-of-network
$5,000 Annual allowance for combined comprehensive dental and preventive services (combined in- and out-of-network)
See Flexible Benefits Card section for information on an additional allowance.
Comprehensive Dental Care $0 Copay for routine plan-covered comprehensive services in-network/$0 Copay for routine plan-covered comprehensive services out-of-network
$5,000 Annual allowance for combined comprehensive dental and preventive services (combined in- and out-of-network)
See Flexible Benefits Card section for information on an additional allowance.
Hearing $20 Copay for routine hearing exam in-network/$20 Copay for routine hearing exam out-of-network
$0 Copay for hearing aid fitting/evaluation (covered once every calendar year) in- and out-of-network combined
$1,000 Allowance for up to 2 hearing aids every calendar year (both ears combined) in- and out-of-network combined
See Flexible Benefits Card section for information on an additional allowance.
Transportation Assistance $0 Copay in-network for up to 24 one-way trips to approved locations per calendar year
SilverSneakers Included at no additional cost
Travel Benefits Emergency or urgent care coverage if you are making a trip out of state or country
Flexible Benefits Card $520 Allowance for OTC items, non-Medicare covered dental, vision and hearing
Applied quarterly in $130 increments
The Flexible Benefits Card is not a credit card, cannot be converted to cash, cannot be used to pay plan premiums, and cannot be used to pay for non-covered Flexible Benefit card services.
Vision Care $0 Copay for routine eye exam
$0 Copay for eyewear (eyeglass frames and lenses or contact lenses)
$200 allowance for eyewear every calendar year
See Flexible Benefits Card section for information on an additional allowance.
Preventive Dental Care $0 Copay
$3,000 Annual allowance for combined comprehensive dental and preventive services
See Flexible Benefits Card section for information on an additional allowance.
Comprehensive Dental Care $0 Copay for routine plan-covered comprehensive services
$3,000 Annual allowance for combined comprehensive dental and preventive services
See Flexible Benefits Card section for information on an additional allowance.
Hearing $20 Copay for routine hearing exam
$0 Copay for hearing aid fitting/evaluation (covered once every calendar year)
$2,000 Allowance for up to 2 hearing aids every calendar year (both ears combined)
See Flexible Benefits Card section for information on an additional allowance.
Transportation Assistance $0 Copay for 24 one-way trips to approved locations per calendar year
SilverSneakers Included at no additional cost
Travel Benefits Emergency or urgent care coverage if you are making a trip out of state or country

This is a summary of the plan benefits. Limitations, copayments, and exclusions may apply. See Evidence of Coverage or contact the plan for more details.

For the 2024 plan year, there are 2 plans available in your area

Add to compare

Essence Advantage Choice
(PPO)

$0
Monthly Premium

Benefits Overview
  • Primary Doctor Copay $0
  • Specialist Copay $30
  • Annual Deductible $0
  • Generic Rx Drug Copay $0
  • Max. Out-of-Pocket Cost $3,900
  • Vision Care
  • Dental Coverage
  • Hearing Benefits
  • Transportation Assistance
  • Fitness Club Membership
  • Worldwide Coverage while Traveling
  • Generous Over-the-Counter Allowance

Click Edit Pharmacies below to add pharmacy preferences and view estimated drug costs.

Add to compare

Essence Advantage
(HMO)

$0
Monthly Premium

Benefits Overview
  • Primary Doctor Copay $0
  • Specialist Copay $30
  • Annual Deductible $0
  • Generic Rx Drug Copay $0
  • Max. Out-of-Pocket Cost $3,650
  • Vision Care
  • Dental Coverage
  • Hearing Benefits
  • Transportation Assistance
  • Fitness Club Membership
  • Worldwide Coverage while Traveling
  • Generous Over-the-Counter Allowance

Click Edit Pharmacies below to add pharmacy preferences and view estimated drug costs.

Select up to 3 Pharmacies

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