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Essence Advantage Premier Plus (PPO)

Illinois Medicare Advantage Plan (2025 Plan)

Monthly Premium

Your Cost
$247
by Essence Healthcare

Additional Coverage

Hearing

Overall Government Star Rating

 4.0
out of 5 stars

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Plan Overview

Plan Name
Essence Advantage Premier Plus (PPO)
Insurance Carrier
Essence Healthcare
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO

Essence Advantage Premier Plus (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Illinois and offered by the health insurance company Essence Healthcare. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Cost Summary

Monthly Premium
$247
Annual Deductible
$0
Max Out-of-Pocket
$1,000
Primary doctor visit
$0 copay
Specialist visit
$0 copay
ER visit
$0 copay
Ambulance
$0 copay

Essence Advantage Premier Plus (PPO) has a monthly premium cost of $247 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $1,000 In and Out-of-network $1,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Essence Advantage Premier Plus (PPO) are defined below.

Additional Benefits and Coverage

Yes
Part D Prescription Drug Coverage
No
Dental
No
Vision
Yes
Hearing

Essence Advantage Premier Plus (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Essence Advantage Premier Plus (PPO) includes coverage for hearing.

Medicare Advantage health plans can offer even more additional benefits. Essence Advantage Premier Plus (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Not covered
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Comparing the Quality Score of Essence Advantage Premier Plus (PPO) to Other Plans in Illinois

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Essence Advantage Premier Plus (PPO) received an overall government quality rating of 4.0 stars out of 5 stars.

Essence Advantage Premier Plus (PPO) performed better than Illinois’s State average overall quality score of 3.7 stars.

This Plan’s 5-star Gov’t Quality Score
Illinois State Average Score
Overall Government 5 Star Quality Rating
 4.0
 3.7
Summary rating of health plan quality
 4
 3.6
Staying healthy: screenings, tests, & vaccines
 5
 3.7
Managing chronic (long term) conditions
 3
 3.3
Member experience with health plan
 4
 3.7
Member complaints & changes in the health plan's performance
 4
 3.8
Health plan customer service
(coming soon)
 3.7
Summary rating of drug plan quality
 3.5
 3.6
Drug plan customer service
 4
 4.1
Member complaints & changes in the drug plan's performance
 4
 3.8
Member experience with the drug plan
 4
 3.6
Drug safety & accuracy of drug pricing
 3
 3.2

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Essence Advantage Premier Plus (PPO) received 4 stars for its health plan quality score which is better than the Illinois State average health plan quality score of 3.6 stars.

Essence Advantage Premier Plus (PPO) received 3.5 stars for its drug plan quality score which is worse than the Illinois State average drug plan quality score of 3.6 stars.

Plan Benefits and Coverage Details

Monthly Premium
$247
Health Portion of Premium
$205
Drug Portion of Premium
$42
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$1,000 In and Out-of-network
$1,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
No
Dental Coverage included
No
Doctor Lookup Link
http://www.essencehealthcare.com
Plan Link
http://www.essencehealthcare.com

Medical Benefits

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist visit
In-network: $0 copay
Out-of-network: $0 copay

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: $0 copay
Lab services
In-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays
In-network: $0 copay
Out-of-network: $0 copay
Emergency care
$0 copay
Urgent care
$0 copay

Hospital Services

Inpatient hospital coverage
In-network: $500 per stay
Out-of-network: $500 per stay
Outpatient hospital coverage
In-network: $0 copay
Out-of-network: $0 copay

Skilled nursing facility

Skilled nursing facility
In-network: $0 copay
Out-of-network: $0 copay

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance
In-network: $0 copay
Out-of-network: $0 copay

Therapy services

Occupational therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist
In-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit
In-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit
In-network: $0 copay
Out-of-network: $0 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: $0 copay
Out-of-network: $0 copay
Prosthetics (like braces, artificial limbs)
In-network: $0 copay
Out-of-network: $0 copay
Diabetes supplies
In-network: $0 copay
Out-of-network: $0 copay

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$15.00 copay$0 copay
Generic$20.00 copay$0 copay
Preferred Brand$47.00 copay$0 copay
Non-Preferred Drug46% coinsurance$0 copay
Specialty Tier25% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 20% coinsurance

Extra Benefits

Hearing

Hearing exam
In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Oral exam
Not covered
Cleaning
Not covered
Fluoride treatment
Not covered
Dental x-rays
Not covered

Comprehensive dental

Restorative services
Not covered
Endodontics
Not covered
Periodontics
Not covered
Prosthodontics, removable
Not covered
Prosthodontics, fixed
Not covered
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
Not covered
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
Not covered
Contact lenses
Not covered
Eyeglasses (frames & lenses)
Not covered
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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