We’ve got you covered from head to toe

$0 Premium and NO Deductibles

With Essence Advantage, 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 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

For more details and a complete list of all benefits, please review our Summary of Benefits (Last Updated 10/1/2022).

Essence Advantage (HMO)
Monthly Premium
Monthly Premium $0
Maximum Out-of-Pocket Limit
Maximum Out-of-Pocket Limit $3,200 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 $35 Copay
Urgent Care
Urgent Care $45 Copay
Emergency Care
Emergency Care $125 Copay
Lab Services
Lab Services $5 Copay
Home Health Care
Home Health Care 100% Coverage
Chiropractic Care
Chiropractic Care $20 Copay
Inpatient Hospital Care
Inpatient Hospital Care $295 Copay Per Day, Per Stay for Days 1-6
$0 Per Day, Per Stay for Days 7 and Beyond
Outpatient Surgery at Hospital
Outpatient Surgery at Hospital $220 Copay
Outpatient Surgery at Ambulatory Surgery Center
Outpatient Surgery at Ambulatory Surgery Center $220 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 (HMO)

Preferred Pharmacies
Other Network Pharmacies
Annual Deductible
Annual Deductible $0
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
Select Insulins
Tier 3 – Preferred Brands
Select Insulins†
Tier 3 – Preferred Brands $42 Copay*
Tier 3 – Preferred Brands $47 Copay*
Select Insulins
Select Insulins
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*
Tier 5 – Specialty Drugs 33% Coinsurance*
Tier 6 – Insulins
Tier 6 – Insulins $0 Copay*
Tier 6 – Insulins $0 Copay*
Initial Coverage Limits
Initial Coverage Limits $4,660 Per Year
Initial Coverage Limits $4,660 Per Year

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.

$O Copays for insulins during the initial coverage phase.

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

smiling couple making cooking together

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

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 Decision Guide

Download your FREE Medicare Advantage decision guide or request a copy by mail.

Schedule a one-on-one consultation

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

Attend a Medicare Seminar

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

Talk with a licensed Medicare advisor

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