Essence Advantage Choice (PPO)

Senior Couple Relaxing In Autumn Landscape

We’ve got you covered from head to toe.

$0 Premium and NO Deductibles

With Essence Advantage Choice, 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 Choice 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.

No or Low 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 low or no copay 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 Choice (PPO)

Monthly Premium

Monthly Premium — $0

Maximum Out-of-Pocket Limit

Maximum Out-of-Pocket Limit — INN $6,900; combined INN+OON $12,000 Per Year

Annual Deductible

Annual Deductible — $0

Preventive Care/Screenings

Preventive Care/Screenings — $0 Copay

Primary Care Physician Visits

Primary Care Physician Visits — In Network: $0 Copay
Out of Network: $25 Copay

Specialist Doctor Visits

Specialist Doctor Visits — In Network: $35 Copay
Out of Network: $50 Copay

Urgent Care

Urgent Care — $50 Copay

Emergency Care

Emergency Care — $95 Copay

Lab Services

Lab Services — In Network: $5 Copay
Out of Network: 35% Coinsurance

Home Health Care

Home Health Care — In Network: 100% Coverage
Out of Network: 35% Coinsurance

Chiropractic Care

Chiropractic Care — In Network: $20 Copay per visit
Out of Network: 35% Coinsurance

Inpatient Hospital Care

Inpatient Hospital Care — In Network: $370 Per Day for Days 1-5 $0 Per Day for Days 6 and Beyond
Out of Network: 35% Coinsurance

Outpatient Surgery at Hospital

Outpatient Surgery at Hospital — In Network: $365 Copay
Out of Network: 35% Coinsurance

Outpatient Surgery at Ambulatory Surgery Center

Outpatient Surgery at Ambulatory Surgery Center — In Network: $325 Copay
Out of Network: 35% Coinsurance

Part D Drug Coverage

Essence Advantage Choice (PPO)

Annual Deductible

Annual Deductible — $0

Tier 1 – Preferred Generics

Tier 1 – Preferred Generics — $0 Copay*

Tier 1 – Preferred Generics — $5 Copay*

Tier 2 – Generics

Select Insulins†

Tier 2 – Generics — $5 Copay*

Tier 2 – Generics — $10 Copay*

Select Insulins — $5 Copay*

Select Insulins — $10 Copay*

Tier 3 – Preferred Brands

Select Insulins†

Tier 3 – Preferred Brands — $42 Copay*

Tier 3 – Preferred Brands — $47 Copay*

Select Insulins — $35 Copay*

Tier 4 – Non-Preferred Brands

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

Tier 4 – Non-Preferred Brands — $100 Copay*

Tier 5 – Specialty Drugs

Tier 5 – Specialty Drugs — 33% Coinsurance*

Initial Coverage Limits

Initial Coverage Limits — $4,660 Per Year

*30-Day Supply

Drug Price Search Tool

Pharmacy Search Tool

Insulin Coverage

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), your Extra Help status or whether the insulin product is considered a Select Insulin under the plan’s Prescription Drug Formulary.^†

Standard Retail Cost Sharing

Tier 2 Select Insulins^†

30-Day Supply: $10 Copay
60-Day Supply: $20 Copay
90-Day Supply: $30 Copay

Tier 3 Select Insulins^†

30-Day Supply: $35 Copay
60-Day Supply: $70 Copay
90-Day Supply: $105 Copay

Standard Mail-Order Cost Sharing

Tier 2 Select Insulins^†

30-Day Supply: Not Offered
60-Day Supply: Not Offered
90-Day Supply: $12.50 Copay

Tier 3 Select Insulins^†

30-Day Supply: Not Offered
60-Day Supply: Not Offered
90-Day Supply: $105 Copay

^†Select Insulins are those that are part of the Insulin Savings Program and incur low, consistent copays through the coverage gap. Insulins administered via a durable medical equipment insulin pump are not included in the program. For information regarding which insulins are Select Insulins under the plan’s benefit, refer to the plan’s Prescription Drug Formulary. See the Evidence of Coverage for more information regarding Select Insulins, including full cost-sharing information. The program doesn’t apply during the catastrophic coverage stage or if you receive Extra Help.

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