Preferred pharmacies*
Other network pharmacies*
Greater St. Louis Area Medicare Advantage Plans
Go back to the 2024 Essence Healthcare plan-year website
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Hospital & Medical Coverage |
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| Preventative care/screening | |||
| Primary care physician visits | |||
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| Urgent care | |||
| Emergency care | |||
| Lab services | |||
| Home health visit | |||
| Chiropractic care | |||
| Inpatient hospital care | |||
| Outpatient surgery at hospital | |||
| Outpatient surgery at ambulatory surgery center |
Drug Coverage |
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Preferred pharmacies*
Other network pharmacies*
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Preferred pharmacies*
Other network pharmacies*
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| Annual deductible |
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| Tier 1 – Preferred Generic |
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| Tier 2 – Generics |
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| Tier 3 – Preferred Brands |
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| Tier 4 – Non-Preferred Brands |
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| Tier 5 – Specialty Drugs |
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| Initial Coverage Limits |
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Extra Benefits |
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Essence Advantage Choice (PPO) Plan Details
$0
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Essence Advantage Choice Plus (PPO) Plan Details
$27
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Essence Advantage (HMO) Plan Details
$0
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Essence Advantage Select (HMO) Plan Details
$0
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Essence Advantage Plus (HMO) Plan Details
$60
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Hospital & Medical Coverage
| Maximum out of pocket | $4,200 Per year in-network/$8,950 Per year combined in-network and out-of-network |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $0 Copay in-network/$25 Copay out-of-network |
| Specialist doctor visits | $35 Copay in-network/$70 Copay out-of-network |
| Urgent care | $40 Copay |
| Emergency care | $110 Copay |
| Lab services | $0 Copay |
| Home health visit | $0 Copay in-network/40% Coinsurance out-of-network |
| Chiropractic care | $20 Copay in-network/40% Coinsurance out-of-network |
| Inpatient hospital care | $290 Copay per day for days 1-6 and $0 Copay per day for day 7 and beyond in-network/40% Coinsurance per day for day 1 and beyond out-of-network |
| Outpatient surgery at hospital | $280 Copay in-network/40% Coinsurance out-of-network |
| Outpatient surgery at ambulatory surgery center | $240 Copay in-network/40% Coinsurance out-of-network |
| Maximum out of pocket | $3,900 Per year in-network/$7,900 Per year combined in-network and out-of-network |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $0 Copay in-network/$20 Copay out-of-network |
| Specialist doctor visits | $25 Copay in-network/$50 Copay out-of-network |
| Urgent care | $40 Copay |
| Emergency care | $110 Copay |
| Lab services | $0 Copay |
| Home health visit | $0 Copay in-network/40% Coinsurance out-of-network |
| Chiropractic care | $20 Copay in-network/40% Coinsurance out-of-network |
| Inpatient hospital care | $290 Copay per day for days 1-6 and $0 Copay per day for day 7 and beyond in-network/40% Coinsurance per day for day 1 and beyond out-of-network |
| Outpatient surgery at hospital | $280 Copay in-network/40% Coinsurance out-of-network |
| Outpatient surgery at ambulatory surgery center | $240 Copay in-network/40% Coinsurance out-of-network |
| Maximum out of pocket | $1,950 Per Year |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $0 Copay |
| Specialist doctor visits | $25 Copay |
| Urgent care | $35 Copay |
| Emergency care | $125 Copay |
| Lab services | $0 Copay |
| Home health visit | $0 Copay |
| Chiropractic care | $20 Copay per visit |
| Inpatient hospital care | $240 Per Day for Days 1-8, $0 Per Day for Days 9 and Beyond |
| Outpatient surgery at hospital | $230 Copay |
| Outpatient surgery at ambulatory surgery center | $175 Copay |
| Maximum out of pocket | $2,800 Per Year |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $0 Copay |
| Specialist doctor visits | $30 Copay |
| Urgent care | $35 Copay |
| Emergency care | $125 Copay |
| Lab services | $0 Copay |
| Home health visit | $0 Copay |
| Chiropractic care | $20 Copay per visit |
| Inpatient hospital care | $260 Per Day for Days 1-8, $0 Per Day for Days 9 and Beyond |
| Outpatient surgery at hospital | $250 Copay |
| Outpatient surgery at ambulatory surgery center | $175 Copay |
| Maximum out of pocket | $1,700 Per Year |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $0 Copay |
| Specialist doctor visits | $30 Copay |
| Urgent care | $25 Copay |
| Emergency care | $125 Copay |
| Lab services | $0 Copay |
| Home health visit | $0 Copay |
| Chiropractic care | $15 Copay per visit |
| Inpatient hospital care | $195 Per Day for Days 1-9, $0 Per Day for Days 10 and Beyond |
| Outpatient surgery at hospital | $150 Copay |
| Outpatient surgery at ambulatory surgery center | $100 Copay |
Drug Coverage
| Preferred Pharmacies* | Other Network Pharmacies* | |
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| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $4 Copay* |
| Tier 2 – Generics | $0 Copay* | $12 Copay* |
| Tier 3 – Preferred Brands | $45 Copay* | $47 Copay* |
| Tier 4 – Non-Preferred Brands | $95 Copay* | $100 Copay* |
| Tier 5 – Specialty Drugs | 33% Coinsurance* | 33% Coinsurance* |
| Initial Coverage Limits | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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| Preferred Pharmacies* | Other Network Pharmacies* | |
|---|---|---|
| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $4 Copay* |
| Tier 2 – Generics | $0 Copay* | $12 Copay* |
| Tier 3 – Preferred Brands | $45 Copay* | $47 Copay* |
| Tier 4 – Non-Preferred Brands | $95 Copay* | $100 Copay* |
| Tier 5 – Specialty Drugs | 33% Coinsurance* | 33% Coinsurance* |
| Initial Coverage Limits | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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| Preferred Pharmacies* | Other Network Pharmacies* | |
|---|---|---|
| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $4 Copay* |
| Tier 2 – Generics | $0 Copay* | $12 Copay* |
| Tier 3 – Preferred Brands | $39 Copay* | $47 Copay* |
| Tier 4 – Non-Preferred Brands | $75 Copay* | $100 Copay* |
| Tier 5 – Specialty Drugs | 33% Coinsurance* | 33% Coinsurance* |
| Tier 6 – Insulins | $0 Copay* | $0 Copay* |
| Initial Coverage Limits | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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| Preferred Pharmacies* | Other Network Pharmacies* | |
|---|---|---|
| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $4 Copay* |
| Tier 2 – Generics | $0 Copay* | $12 Copay* |
| Tier 3 – Preferred Brands | $39 Copay* | $47 Copay* |
| Tier 4 – Non-Preferred Brands | $75 Copay* | $100 Copay* |
| Tier 5 – Specialty Drugs | 33% Coinsurance* | 33% Coinsurance* |
| Tier 6 – Insulins | $0 Copay* | $0 Copay* |
| Initial Coverage Limits | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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| Preferred Pharmacies* | Other Network Pharmacies* | |
|---|---|---|
| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $4 Copay* |
| Tier 2 – Generics | $0 Copay* | $12 Copay* |
| Tier 3 – Preferred Brands | $34 Copay* | $42 Copay* |
| Tier 4 – Non-Preferred Brands | $65 Copay* | $80 Copay* |
| Tier 5 – Specialty Drugs | 33% Coinsurance* | 33% Coinsurance* |
| Tier 6 – Insulins | $0 Copay* | $0 Copay* |
| Initial Coverage Limits | $4,660 Per Year | $4,660 Per Year |
*30-Day supply. |
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Prescriptions
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Drug Costs
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Extra Benefits
| Flexible Benefits Card | $1,500 Allowance for OTC items, non-Medicare covered dental, vision and hearing Applied quarterly in $375 increments The Flexible Benefits Card is not a credit card, cannot be converted to cash, cannot be used to pay plan premiums, and cannot be used to pay for non-covered Flexible Benefit card services. |
| Vision Care | $0 Copay in-network for routine eye exam/$0 Copay out-of-network for routine eye exam See Flexible Benefits Card section for information on an additional allowance. |
| Preventive Dental Care | $0 Copay in-network/$0 Copay out-of-network See Flexible Benefits Card section for information on an additional allowance. |
| Comprehensive Dental Care | $35 Copay for in-network Medicare-covered services/$70 Copay for out-of-network Medicare-covered services See Flexible Benefits Card section for information on an additional allowance. |
| Over-the-Counter (OTC) Items | Included as part of the Flexible Benefits Card |
| Hearing | $20 Copay for routine hearing exam in-network/$20 Copay for routine hearing exam out-of-network See Flexible Benefits Card section for information on an additional allowance. |
| Transportation Assistance | $0 Copay in-network for up to 24 one-way trips to approved locations per calendar year |
| SilverSneakers | Included at no additional cost |
| Travel Benefits | Emergency or urgent care coverage if you are making a trip out of state or country |
| Flexible Benefits Card | $2,500 Allowance for OTC items, non-Medicare covered dental, vision and hearing Applied quarterly in $625 increments The Flexible Benefits Card is not a credit card, cannot be converted to cash, cannot be used to pay plan premiums, and cannot be used to pay for non-covered Flexible Benefit card services. |
| Vision Care | $0 Copay in-network for routine eye exam/$0 Copay out-of-network for routine eye exam See Flexible Benefits Card section for information on an additional allowance. |
| Preventive Dental Care | $0 Copay in-network/$0 Copay out-of-network See Flexible Benefits Card section for information on an additional allowance. |
| Comprehensive Dental Care | $25 Copay for in-network Medicare-covered services/$50 Copay for out-of-network Medicare-covered services See Flexible Benefits Card section for information on an additional allowance. |
| Over-the-Counter (OTC) Items | Included as part of the Flexible Benefits Card |
| Hearing | $20 Copay for routine hearing exam in-network/$20 Copay for routine hearing exam out-of-network See Flexible Benefits Card section for information on an additional allowance. |
| Transportation Assistance | $0 Copay in-network for up to 24 one-way trips to approved locations per calendar year |
| SilverSneakers | Included at no additional cost |
| Travel Benefits | Emergency or urgent care coverage if you are making a trip out of state or country |
| Flexible Benefits Card | $110 quarterly allowance for over-the-counter items The Flexible Benefits Card is not a credit card, cannot be converted to cash, cannot be used to pay plan premiums, and cannot be used to pay for non-covered Flexible Benefit card services. |
| Vision Care | $0 Copay for routine eye exam, $0 Copay for eyewear (eyeglass frames and lenses or contact lenses), $200 allowance every 2 calendar years |
| Preventive Dental Care | $0 Copay |
| Comprehensive Dental Care | $25 Copay for Medicare-covered services |
| Over-the-Counter (OTC) Items | Included as part of the Flexible Benefits Card |
| Hearing | $1,000 Allowance for up to 2 hearing aids every 2 calendar years (both ears combined) $20 Copay for routine hearing exam $0 Copay for hearing aid fitting/evaluation (covered once every 2 calendar years) |
| Transportation Assistance | $0 Copay for 24 one-way trips to approved locations per calendar year |
| SilverSneakers | Included at no additional cost |
| Travel Benefits | Emergency or urgent care coverage if you are making a trip out of state or country |
| Flexible Benefits Card | $640 Allowance for OTC items, non-Medicare covered dental, vision and hearing Applied quarterly in $160 increments The Flexible Benefits Card is not a credit card, cannot be converted to cash, cannot be used to pay plan premiums, and cannot be used to pay for non-covered Flexible Benefit card services. |
| Vision Care | $0 Copay for routine eye exam, $0 Copay for eyewear (eyeglass frames and lenses or contact lenses), $200 allowance every 2 calendar years See Flexible Benefits Card section for information on an additional allowance |
| Preventive Dental Care | $0 Copay See Flexible Benefits Card section for information on an additional allowance. |
| Comprehensive Dental Care | $1,500 Maximum Benefit Per Year (Preventive and Comprehensive combined); 20-50% co-insurance See Flexible Benefits Card section for information on an additional allowance. |
| Over-the-Counter (OTC) Items | Included as part of the Flexible Benefits Card |
| Hearing | $1,000 Allowance for up to 2 hearing aids every 2 calendar years (both ears combined) $20 Copay for routine hearing exam $0 Copay for hearing aid fitting/evaluation (covered once every 2 calendar years) See Flexible Benefits Card section for information on an additional allowance. |
| Transportation Assistance | $0 Copay for 24 one-way trips to approved locations per calendar year |
| SilverSneakers | Included at no additional cost |
| Travel Benefits | Emergency or urgent care coverage if you are making a trip out of state or country |
| Flexible Benefits Card | $110 quarterly allowance for over-the-counter items The Flexible Benefits Card is not a credit card, cannot be converted to cash, cannot be used to pay plan premiums, and cannot be used to pay for non-covered Flexible Benefit card services. |
| Vision Care | $0 Copay for routine eye exam, $0 Copay for eyewear (eyeglass frames and lenses or contact lenses), $200 allowance every 2 calendar years |
| Preventive Dental Care | $0 Copay |
| Comprehensive Dental Care | $30 Copay for Medicare-covered services |
| Over-the-Counter (OTC) Items | Included as part of the Flexible Benefits Card |
| Hearing | $1,000 Allowance for up to 2 hearing aids every 2 calendar years (both ears combined) $20 Copay for routine hearing exam $0 Copay for hearing aid fitting/evaluation (covered once every 2 calendar years) |
| Transportation Assistance | $0 Copay for 24 one-way trips to approved locations per calendar year |
| SilverSneakers | Included at no additional cost |
| Travel Benefits | Emergency or urgent care coverage if you are making a trip out of state or country |
This is a summary of the plan benefits. Limitations, copayments, and exclusions may apply. See Evidence of Coverage or contact the plan for more details.
Plan Documents
For the 2023 plan year, there are 5 plans available in your area
Add to compare
Essence Advantage Choice
(PPO)
$0
Monthly Premium
Benefits Overview
- Primary Doctor Copay $0
- Specialist Copay $35
- Annual Deductible $0
- Generic Rx Drug Copay $0
- Max. Out-of-Pocket Cost $4,200
- Vision Care
- Dental Coverage
- Hearing Benefits
- Transportation Assistance
- Fitness Club Membership
- Worldwide Coverage while Traveling
- Generous Over-the-Counter Allowance
Click Edit Pharmacies below to add pharmacy preferences and view estimated drug costs.
Add to compare
Essence Advantage Choice Plus
(PPO)
$27
Monthly Premium
Benefits Overview
- Primary Doctor Copay $0
- Specialist Copay $25
- Annual Deductible $0
- Generic Rx Drug Copay $0
- Max. Out-of-Pocket Cost $3,900
- Vision Care
- Dental Coverage
- Hearing Benefits
- Transportation Assistance
- Fitness Club Membership
- Worldwide Coverage while Traveling
- Generous Over-the-Counter Allowance
Click Edit Pharmacies below to add pharmacy preferences and view estimated drug costs.
Add to compare
Essence Advantage
(HMO)
$0
Monthly Premium
Benefits Overview
- Primary Doctor Copay $0
- Specialist Copay $25
- Annual Deductible $0
- Generic Rx Drug Copay $0
- Max. Out-of-Pocket Cost $1,950
- Vision Care
- Dental Coverage
- Hearing Benefits
- Transportation Assistance
- Fitness Club Membership
- Worldwide Coverage while Traveling
- Generous Over-the-Counter Allowance
Click Edit Pharmacies below to add pharmacy preferences and view estimated drug costs.
Add to compare
Essence Advantage Select
(HMO)
$0
Monthly Premium
Benefits Overview
- Primary Doctor Copay $0
- Specialist Copay $30
- Annual Deductible $0
- Generic Rx Drug Copay $0
- Max. Out-of-Pocket Cost $2,800
- Vision Care
- Dental Coverage
- Hearing Benefits
- Transportation Assistance
- Fitness Club Membership
- Worldwide Coverage while Traveling
- Generous Over-the-Counter Allowance
Click Edit Pharmacies below to add pharmacy preferences and view estimated drug costs.
Add to compare
Essence Advantage Plus
(HMO)
$60
Monthly Premium
Benefits Overview
- Primary Doctor Copay $0
- Specialist Copay $30
- Annual Deductible $0
- Generic Rx Drug Copay $0
- Max. Out-of-Pocket Cost $1,700
- Vision Care
- Dental Coverage
- Hearing Benefits
- Transportation Assistance
- Fitness Club Membership
- Worldwide Coverage while Traveling
- Generous Over-the-Counter Allowance
Click Edit Pharmacies below to add pharmacy preferences and view estimated drug costs.
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