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Essence Healthcare has been awarded an Overall Plan Rating of 5 out of 5 stars from the Centers for Medicare & Medicaid Services (CMS).
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Essence Healthcare includes HMO, HMO-POS, and PPO plans with Medicare contracts. Essence Healthcare also includes an HMO D-SNP plan with a contract with Medicare and the state Medicaid program. Enrollment in Essence Healthcare depends on contract renewal. All Essence Healthcare plans include Part D drug coverage.

To enroll in an Essence plan, you must have both Medicare Parts A and B and reside in the plan service area. You must have both Medicare Parts A and B and Missouri Medicaid with QMB or QMB Plus eligibility to enroll in an Essence Healthcare HMO D-SNP plan. You must continue to pay your Medicare Part B premium (unless your Part B premium is paid for you by Medicaid or another third party). Enrollment in an Essence Healthcare plan may be limited to specific times of the year.

Members enrolled in an Essence Healthcare HMO or HMO D-SNP 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, Essence Healthcare will not be responsible for the costs.

Members enrolled in an Essence Healthcare HMO-POS or PPO plan may see out-of-network providers (non-contracted providers). Out-of-network 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.

For accommodations of persons with special needs at meetings, call 1-866-509-5398 (TTY: 711).

Every year, Medicare evaluates plans based on a 5-star rating system.

Benefits, star ratings, and network may vary by plan, contract or market. Please refer to plan documents for additional information or contact Customer Service.

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Y0027_23-574_M — Last updated 10/01/2022

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Erin Venable Print

Erin Venable

Erin brings over a decade of public accounting experience to Essence Healthcare, with nine years focused on the insurance industry serving life, health, property/casualty insurers, captive insurers and reinsurers. She has served companies in all aspects of audit service delivery and related audit and financial reporting matters, including coordination and execution of financial statement audits, review and supervision of staff accountants, and documentation and testing of business processes and internal controls. In her role at Essence, Erin provides strategic vision and oversight to the compliance and internal audit functions of the company. A native of Columbia, Missouri, Erin and her family enjoy all things Mizzou sports.

Joel Anderson

Joel Andersen

Joel is a seasoned executive with over 22 years of experience in the healthcare industry. Prior to his current role at Essence Healthcare, he was a founder and chief marketing officer for Essences sister company, Lumeris, and also served as president of the companys EHR software division (ClearPractice). Before joining the Essence family of companies in 2006, he served as vice president of marketing for e-MDs and held a variety of management positions at several healthcare technology companies, including Trizetto, Nightingale and Mariner Systems. When not at work trying to come up with the next big idea, he enjoys spending time with his wife and son, writing, playing golf or cheering on his favorite sports team, the St. Louis Blues.

Debbie Zimmerman

Debbie Zimmerman, MD

Dr. Zimmerman has a distinguished history of medical leadership at health plans such as CIGNA, Group Health Plan and Health Partners of the Midwest. Before joining Essence Healthcare, she served as chief medical officer of Mercy Health Plans, a providersponsored plan owned by Sisters of Mercy. She is also an accomplished entrepreneur, having co-founded a successful disease and complex case management firm. Dr. Zimmerman practiced internal medicine for 15 years and is licensed to practice in Missouri and Illinois. Outside of the office, Dr. Zimmerman enjoys traveling especially to visit her three children.

Portrait of Martha Butler

Martha Butler

Martha is a talented healthcare executive with more than 25 years of experience in managed care and medical group settings. She has extensive expertise in process improvement, health center administration facilities management, and information systems operations. From 2000 to 2005, she served as executive director of Esse Health, one of the nations largest independent physician groups. Previously, Martha held a number of management positions at Group Health Plan and oversaw the ambulatory surgery department at St. Louis University Hospital. Martha is a native St. Louisan, has three grown children and currently lives in the St. Louis area with her husband.

Richard Jones

Richard Jones

As an experienced healthcare executive and certified public accountant, Richard brings more than 30 years of expertise to his current role of president and CEO. Before joining Essence, Richard served as chief financial officer of Essence Group Holdings Corporation (including Essence Healthcare), national president of United Healthcares Medicare and Medicaid lines of business, president and CEO of Coventry Healthcare of the Midwest, and chief financial officer of Coventry Corporation.