Essence
Advantage Plus (HMO)
Plan Details

man looking at book with son
5-Stars

Essence Healthcare has been awarded an Overall Plan Rating of 5 out of 5 stars from the Centers for Medicare and Medicaid (CMS).

We’ve got you covered from head to toe.

Complete Coverage With One Plan From One Company

Unlike traditional Medicare plans, Essence Advantage Plus bundles your medical, hospital and prescription drug coverage together in one comprehensive plan. Our plan comes with valuable extra benefits that save you even more.

Low Monthly Premium and NO Deductibles

Essence Advantage Plus is available for a $66 monthly premium.

There are also no annoying deductibles to meet. Your coverage begins right away.

Additional Prescription Drug Coverage

Essence Advantage Plus provides extra prescription drug coverage including lower copays for brand-name medications and more coverage in the Part D coverage gap (Donut Hole). If your prescription drug costs are typically higher than average, you will definitely appreciate this extra coverage.

$0 Copays on Generic Prescriptions

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

Important Financial Protection

Essence 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 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 and urgent-care coverage.

Benefits at a Glance

Hospital and Medical Coverage

For more details and a complete list of all benefits, please review our Summary of Benefits (Updated: 09/30/2021).

Essence Advantage Plus (HMO)
Monthly Premium
Monthly Premium — $66
Maximum Out-of-Pocket Limit
Maximum Out-of-Pocket Limit — $1,700 Per Year
Annual Deductible
Annual Deductible — $0
Preventive Care/Screenings
Preventive Care/Screenings — $0 Copay
Primary Care Physician Visits
Primary Care Physician Visits — $0 Copay
Specialist Doctor Visits
Specialist Doctor Visits — $30 Copay
Urgent Care
Urgent Care — $25 Copay
Emergency Care
Emergency Care — $120 Copay
Lab Services
Lab Services — 0% Co-insurance
Home Health Care
Home Health Care — 100% Coverage
Chiropractic Care
Chiropractic Care — $15 Copay per visit
Inpatient Hospital Care
Inpatient Hospital Care — $195 Per Day for Days 1-9, $0 Per Day for Days 10 and Beyond
Outpatient Surgery at Hospital
Outpatient Surgery at Hospital — $150 Copay
Outpatient Surgery at Ambulatory Surgery Center
Outpatient Surgery at Ambulatory Surgery Center — $100 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 Plus (HMO)

Preferred Pharmacies
Other Network Pharmacies
Annual Deductible
Annual Deductible — $0
Annual Deductible — $0
Tier 1 – Preferred Generic
Tier 1 – Preferred Generic — $0 Copay*
Tier 1 – Preferred Generic — $4 Copay*
Tier 2 – Generics
Tier 2 – Generics — $0 Copay*
Tier 2 – Generics — $12 Copay*
Tier 3 – Preferred Brands
Tier 3 – Preferred Brands — $34 Copay*
Tier 3 – Preferred Brands — $42 Copay*
Tier 4 – Non-Preferred Brands
Tier 4 – Non-Preferred Brands — $65 Copay*
Tier 4 – Non-Preferred Brands — $80 Copay*
Tier 5 – Specialty Drugs
Tier 5 – Specialty Drugs — 33% Co-insurance*
Tier 5 – Specialty Drugs — 33% Co-insurance*
Tier 6 – Insulins
Tier 6 – Insulins — $0 Copay*
Tier 6 – Insulins — $0 Copay*
Initial Coverage Limits
Initial Coverage Limits — $4,430 Per Year
Initial Coverage Limits — $4,430 Per Year

*30-Day Supply

senior couple walking in park

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.

Learn More

Important Plan Documents

Ready to get the all-in-one coverage of an Essence Healthcare plan?

We make it easy for you to get the information you need, when and how you need it.

Request your FREE Information Kit

Download your FREE Medicare Advantage info kit or request a copy by mail.

Request Info Kit

Schedule a one-on-one consultation

Get all your questions answered in a one-on-one appointment with a licensed Medicare advisor.

Schedule Consultation

Attend a Medicare Seminar

Learn more about Essence Healthcare plans at one of our FREE local or online Medicare seminars.

View Seminar Schedule

Talk with a licensed Medicare advisor

Call anytime to discuss your options with a local, licensed Essence Healthcare advisor.

1-866-509-5398 (TTY: 711)