Preferred pharmacies*
Other network pharmacies*
Greater Cincinnati Medicare Advantage Plans
Go back to the 2024 Essence Healthcare plan-year website
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Hospital & Medical Coverage |
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| Emergency care | |||
| Lab services | |||
| Home health visit | |||
| Chiropractic care | |||
| Inpatient hospital care | |||
| Outpatient surgery at hospital | |||
| Outpatient surgery at ambulatory surgery center |
Drug Coverage |
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Preferred pharmacies*
Other network pharmacies*
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Preferred pharmacies*
Other network pharmacies*
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| Annual deductible |
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| Tier 1 – Preferred Generic |
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| Tier 2 – Generics |
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| Tier 3 – Preferred Brands |
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| Tier 4 – Non-Preferred Brands |
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| Tier 5 – Specialty Drugs |
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| Initial Coverage Limits |
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Extra Benefits |
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Essence Advantage Choice (PPO) Plan Details
$0
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Essence Advantage (HMO) Plan Details
$0
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Essence Advantage Plus (HMO) Plan Details
$0
Monthly Premium
$10
Primary Doctor
Copay
Copay
$0
Annual Deductible
Hospital & Medical Coverage
| Maximum out of pocket | In Network: $4,900 Per Year In Network and Out of Network (combined): $8,950 Per Year |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | In Network: $0 Copay Out of Network: $20 Copay |
| Specialist doctor visits | In Network: $45 Copay Out of Network: 40% Coinsurance |
| Urgent care | $45 Copay |
| Emergency care | $110 Copay |
| Lab services | In Network: $5 Copay Out of Network: 40% Coinsurance |
| Home health visit | In Network: $0 Copay Out of Network: 40% Coinsurance |
| Chiropractic care | In Network: $20 Copay per visit Out of Network: 40% Coinsurance |
| Inpatient hospital care | In Network: $375 Per Day for Days 1-5, $0 Per Day for Days 6 and Beyond Out of Network: 40% Coinsurance |
| Outpatient surgery at hospital | In Network: $365 Copay Out of Network: 40% Coinsurance |
| Outpatient surgery at ambulatory surgery center | In Network: $325 Copay Out of Network: 40% Coinsurance |
| Maximum out of pocket | $3,900 Per Year |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $0 Copay |
| Specialist doctor visits | $35 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 Per Day for Days 1-7, $0 Per Day for Days 8 and Beyond |
| Outpatient surgery at hospital | $285 Copay |
| Outpatient surgery at ambulatory surgery center | $245 Copay |
| Maximum out of pocket | $4,700 Per Year |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $10 Copay |
| Specialist doctor visits | $50 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 | $385 Per Day for Days 1-5, $0 Per Day for Days 6 and Beyond |
| Outpatient surgery at hospital | $375 Copay |
| Outpatient surgery at ambulatory surgery center | $335 Copay |
Drug Coverage
| Preferred Pharmacies* | Other Network Pharmacies* | |
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| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $4 Copay* |
| Tier 2 – Generics | $5 Copay* | $12 Copay* |
| Tier 3 – Preferred Brands | $42 Copay* | $47 Copay* |
| Tier 4 – Non-Preferred Brands | $95 Copay* | $100 Copay* |
| Tier 5 – Specialty Drugs | 33% Coinsurance* | 33% Coinsurance* |
| Initial Coverage Limits | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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| Preferred Pharmacies* | Other Network Pharmacies* | |
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| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $5 Copay* |
| Tier 2 – Generics | $5 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 | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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| Preferred Pharmacies* | Other Network Pharmacies* | |
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| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $2 Copay* | $7 Copay* |
| Tier 2 – Generics | $9 Copay* | $14 Copay* |
| Tier 3 – Preferred Brands | $42 Copay* | $47 Copay* |
| Tier 4 – Non-Preferred Brands | $95 Copay* | $100 Copay* |
| Tier 5 – Specialty Drugs | 33% Coinsurance* | 33% Coinsurance* |
| Initial Coverage Limits | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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Prescriptions
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Drug Costs
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Extra Benefits
| Flexible Benefits Card | $500 credit per quarter, supplied in the form of a debit card, to use on health-related over-the-counter items, non-Medicare covered dental, vision and hearing, quarter-to-quarter rollover. 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 | In Network: $0 Copay for routine eye exam, $0 Coplay for one pair of Medicare-covered eyeglass frames and lenses or contact lenses after each cataract surgery. Out of Network: $0 Copay for routine eye exam, 40% Coinsurance for one pair of Medicare-covered eyeglass frames and lenses or contact lenses after each cataract surgery. See Flexible Benefits Card section for information on an additional allowance. |
| Preventive Dental Care | In Network: $0 Copay Out of Network: $0 Copay See Flexible Benefits Card section for information on an additional allowance. |
| Comprehensive Dental Care | In Network: $45 Copay Out of Network: 40% Coinsurance See Flexible Benefits Card section for information on an additional allowance. |
| Hearing | In Network: $20 Copay for routine hearing exam Out of Network: $20 Copay for routine hearing exam See Flexible Benefits Card section for information on an additional allowance. |
| Transportation Assistance | Not covered |
| 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 | $250 credit per quarter, supplied in the form of a debit card, to use on health-related over-the-counter items, non-Medicare covered dental, vision and hearing, quarter-to-quarter rollover. 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) after each cataract surgery. See Flexible Benefits Card section for information on an additional allowance. |
| Preventive Dental Care | $0 Copay See Flexible Benefits Card section for information on an additional allowance. |
| Comprehensive Dental Care | $35 Copay for Medicare-covered services See Flexible Benefits Card section for information on an additional allowance. |
| Hearing | $20 Copay for routine hearing exam 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 |
| Flexible Benefits Card | $500 credit per quarter, supplied in the form of a debit card, to use on health-related over-the-counter items, non-Medicare covered dental, vision and hearing, quarter-to-quarter rollover. 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) after each cataract surgery. See Flexible Benefits Card section for information on an additional allowance. |
| Preventive Dental Care | $0 Copay See Flexible Benefits Card section for information on an additional allowance. |
| Comprehensive Dental Care | $50 Copay for Medicare-covered services See Flexible Benefits Card section for information on an additional allowance. |
| Hearing | $20 Copay for routine hearing exam 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.
Plan Documents
For the 2023 plan year, there are 3 plans available in your area
Add to compare
Essence Advantage Choice
(PPO)
$0
Monthly Premium
Benefits Overview
- Primary Doctor Copay $0
- Specialist Copay $45
- Annual Deductible $0
- Generic Rx Drug Copay $0
- Max. Out-of-Pocket Cost $4,900
- Vision Care
- Dental Coverage
- Hearing Benefits
- 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 $35
- 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 Plus
(HMO)
$0
Monthly Premium
Benefits Overview
- Primary Doctor Copay $10
- Specialist Copay $50
- Annual Deductible $0
- Generic Rx Drug Copay $2
- Max. Out-of-Pocket Cost $4,700
- 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.
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