Essence Advantage Plus (HMO)

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We’ve got you covered from head to toe

Low Monthly Premium and NO Deductibles

Essence Advantage Plus is available for a $60 monthly premium.

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 Plus 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.

$0 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 $0 copays 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.

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.

Benefits at a Glance

Hospital and Medical Coverage

For more benefit details, please review our Summary of Benefits (Last Updated: 10/1/2022).

Essence Advantage Plus (HMO)

Monthly Premium

Monthly Premium — $60

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 — $125 Copay

Lab Services

Lab Services — 0% Coinsurance

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)

Annual Deductible

Annual Deductible — $0

Tier 1 – Preferred Generics

Tier 1 – Preferred Generics — $0 Copay*

Tier 1 – Preferred Generics — $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% Coinsurance*

Tier 6 – Insulins

Tier 6 – Insulins — $0 Copay*

Initial Coverage Limits

Initial Coverage Limits — $4,660 Per Year

*30-Day supply.

Drug Price Search Tool

Pharmacy Search Tool

Insulin Coverage

Important—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) or your Extra Help status.

$0 copays for Tier 6 insulins during the Initial Coverage Stage and Coverage Gap Stage.

Excludes insulins delivered through a pump, which are covered under Part B for 20% coinsurance.

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