Preferred pharmacies*
Other network pharmacies*
Southwest Missouri Medicare Advantage Plans
Go back to the 2024 Essence Healthcare plan-year website
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Hospital & Medical Coverage |
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| Maximum out of pocket | |
| Annual deductible | |
| Preventative care/screening | |
| Primary care physician visits | |
| Specialist doctor visits | |
| 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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| 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 (HMO) Plan Details
$0
Monthly Premium
$0
Primary Doctor
Copay
Copay
$0
Annual Deductible
Hospital & Medical Coverage
| Maximum out of pocket | $3,200 Per Year |
| Annual deductible | $0 |
| Preventative care/screening | $0 Copay |
| Primary care physician visits | $0 Copay |
| Specialist doctor visits | $35 Copay |
| Urgent care | $45 Copay |
| Emergency care | $125 Copay |
| Lab services | $5 Copay |
| Home health visit | $0 Copay |
| Chiropractic care | $20 Copay |
| 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 | $220 Copay |
| Outpatient surgery at ambulatory surgery center | $220 Copay |
Drug Coverage
| Preferred Pharmacies* | Other Network Pharmacies* | |
|---|---|---|
| Annual deductible | $0 | $0 |
| Tier 1 – Preferred Generic | $0 Copay* | $5 Copay* |
| Tier 2 – Generics | $5 Copay* | $10 Copay* |
| Tier 3 – Preferred Brands | $42 Copay* | $47 Copay* |
| Tier 4 – Non-Preferred Brands | $95 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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Prescriptions
No prescriptions have been selected.
Drug Costs
No pharmacies have been selected.
Extra Benefits
| Flexible Benefits Card / Over-the-Counter (OTC) Items | $110 credit per quarter, supplied in the form of a debit card, to use on health-related over-the-counter items, no quarter-to-quarter rollover. 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 | Routine Eye Exam $0 Copay when using an EyeQuest Provider, Eyeglasses $0 Copay, $200 allowance every 2 calendar years |
| Preventive Dental Care | $0 Copay |
| Comprehensive Dental Care | A max benefit of $1,250 for preventative and comprehensive combined |
| Hearing | $1,000 Allowance for up to 2 hearing aids every 2 years (both ears combined) $20 Copay for hearing exam $0 Copay for hearing aid fitting/evaluation (covered once every 2 calendar years) |
| 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 is 1 plan available in your area
Essence Advantage
(HMO)
$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 $3,200
- Vision Care
- Dental Coverage
- Hearing Benefits
- Fitness Club Membership
- Worldwide Coverage while Traveling
- Generous Over-the-Counter Allowance
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