Health Plan RadarIn this article we rank Illinois Medicare Advantage plans based on our evaluation of government 5-star quality scores.
Read more →Essence Advantage Premier Plus (PPO)
by Essence Healthcare
2026 Medicare Advantage plan available in Illinois
Plan ID H6200-011-0
Additional coverage:
RxHearing
Medicare Advantage PPO 3.0 Overall
Monthly plan premium $257 / mo
Annual deductible $0 / yr
Max out-of-pocket · in-network $2,000 / yr
Drug deductible $615 / yr
3.0 Overall Government Star Rating 2026 · out of 5 stars
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Plan Overview
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 the in-network doctors who accept the plan and whether a referral is needed.
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
Cost Summary
Essence Advantage Premier Plus (PPO) has a monthly premium cost of $257 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $2,000. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.
Monthly Premium $257 / mo
Health portion of premium $207
Drug portion of premium $50
Annual Deductible $0 / yr
Max Out-of-Pocket · in-network $2,000 / yr
Primary doctor visit $0 copay
Specialist visit $0 copay
ER visit $0 copay
Ambulance $0 copay
Additional Benefits and Coverage
Essence Advantage Premier Plus (PPO) is a Medicare Advantage plan which includes 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.
Part D Prescription Drug Coverage Yes
Dental No
Vision No
Hearing Yes
Nationwide Coverage No
Other benefits
Fitness benefit Limited coverage
Over-the-counter drug benefits Not covered
In-home support services Not covered
Home & bathroom safety devices Not covered
Meals for short duration Not covered
Annual physical exams Limited coverage
Telehealth Limited coverage
Medical Benefits
Doctor Services
Primary doctor visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Specialist visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Tests, labs & imaging
Diagnostic tests & procedures In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Lab services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Diagnostic radiology services (like MRI) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient x-rays In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Emergency care $0 copay
Urgent care $0 copay
Hospital Services
Inpatient hospital coverage In-network:
Tier 1
$500 per stay
Out-of-network:
$500 per stay
Tier 1
$500 per stay
Out-of-network:
$500 per stay
Outpatient hospital coverage In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Skilled nursing facility
Skilled nursing facility In-network:
$0 copay
Out-of-network:
$ per stay
$0 copay
Out-of-network:
$
Preventive services
Preventive services In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Ambulance
Ground ambulance In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Therapy services
Occupational therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Physical therapy & speech & language therapy visit In-network: $0 copay
Out-of-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
Out-of-network: $0 copay
Outpatient individual therapy with a psychiatrist In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient group therapy visit In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Outpatient individual therapy visit In-network: $0 copay
Out-of-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
Out-of-network: $0 copay
Prosthetics (like braces, artificial limbs) In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Prescription drugs (Part D benefits)
Drug tier standard retail · 1-month supply Initial coverage Catastrophic
Preferred Generic $15.00 copay $0 copay
Generic $20.00 copay $0 copay
Preferred Brand $47.00 copay $0 copay
Non-Preferred Drug 50% coinsurance $0 copay
Specialty Tier 25% coinsurance $0 copay
Part B drugs
Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Out-of-network: 20% coinsurance
Medicare star rating
Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Essence Advantage Premier Plus (PPO) earned an overall rating of 3.0 stars — worse than Illinois's state average of 3.6 stars.
Rating category This plan State average
Overall star rating ★ 3.0 3.6
Health plan quality
Summary rating of health plan quality ★ 3.5 3.6
Staying healthy: screenings, tests & vaccines ★ 4.0 3.5
Managing chronic (long-term) conditions ★ 4.0 3.4
Member experience with health plan ★ 3.0 3.5
Member complaints & changes in performance ★ 3.0 3.7
Health plan customer service ★ 4.0 4.1
Drug plan quality
Summary rating of drug plan quality ★ 3.0 3.4
Drug plan customer service ★ 4.0 4.8
Member complaints & changes in performance ★ 3.0 3.6
Member experience with the drug plan ★ 1.0 3.3
Drug safety & accuracy of drug pricing ★ 4.0 3.6
Extra Benefits
Hearing
Hearing exam In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Hearing aids - prescription In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Hearing aids - over the counter Not covered
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
Plan documents & tools
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