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Health and wellness or prevention information. Important Essence Healthcare information.

The content in this newsletter is provided for information only. Such information does not constitute medical advice and should not be relied on as such. Essence recommends that you consult with your physician for options and the best course of treatment for you.

No obligation to enroll. Other physicians/providers are available in our network.

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. There are no medical or hospital deductibles for any plans. Some plans have a Part D prescription drug deductible.

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 amounts differ by plan. Limitations and exclusions apply to extra benefits. $0 Preferred generic medication copay amounts applicable at preferred pharmacies. Copays are higher for out-of-network services.

Flex Cards not available in all plans. The Flex Card must be used for payment of eligible items and services. Any other forms of payment used aren’t eligible for reimbursement. 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. The Mastercard circles design is a registered trademark of Mastercard International Incorporated.

For accommodations of persons with special needs at meetings, call 1-866-597-9560 (TTY: 711).

*Every year, Medicare evaluates plans based on a 5-star rating system. Essence HMO plans (H2610 contract) received a 5-out-of-5-star Overall Plan Rating for 2022-2024 and a 4.5-star rating for 2025. Essence PPO plans (H6200 contract) achieved a 4-star Overall Plan Rating for 2025. Top-rated plans receive 4 stars or higher from CMS. Plans under Essence’s H3189 and H4620 contracts don’t have enough data to receive 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. Better service, care and benefits compared to plans with an overall rating of less than 5 stars.

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