Important Plan Documents

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Essence Healthcare includes HMO and PPO plans with Medicare contracts. Enrollment in Essence Healthcare depends on contract renewal. All Essence Healthcare plans include Part D drug coverage.

To enroll in an Essence plan, you must have both Medicare Parts A and B and reside in the plan service area. You must continue to pay your Medicare Part B premium. Enrollment in an Essence Healthcare plan may be limited to specific times of the year.

Members enrolled in an Essence Healthcare HMO plan must use plan providers except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from Essence Healthcare, neither Medicare nor Essence Healthcare will be responsible for the costs.

Members enrolled in an Essence Healthcare PPO plan may see out-of-network providers (non-contracted providers). Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Benefits and allowances may differ by plan. Benefit limitations and exclusions may apply to extra benefits.

Total Flex Card allowance is divided equally and applied quarterly. Unused funds roll over from quarter to quarter but expire at the end of the year. For use on certain non-Medicare covered dental, vision and hearing items and services. The Flexible Benefits Card isn’t a credit card, can’t be converted to cash and can’t be used to help pay for plan premiums or for non-covered Flex Card services.

For accommodations of persons with special needs at meetings, call 1-866-509-5398 (TTY: 711).

Essence savings are compared to traditional Medicare. More choices, benefits, flexibility and savings compared to traditional Medicare. More doctors compared to 2023 Essence contracted network.

Dental allowance applies to preventive and comprehensive services combined. $0 Generic medication copay amounts applicable at preferred pharmacies.

*Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings may vary by contract or market. For plan years 2022-2024, plans under Essence Healthcare’s H2610 (HMO) contract achieved a 5-star Overall Plan Rating. Plans under other Essence contracts (H6200, H4620, H3189) are too new to be measured for a Star rating.

Benefits, star ratings, and network may vary by plan, contract or market. Please refer to plan documents for additional information or contact Customer Service.