Essence Advantage Choice (PPO)

Missouri Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$0
by Essence Healthcare

Additional Coverage

HearingVisionDental

Overall Government Star Rating

No Rating (new plan)

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

Essence Advantage Choice (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Missouri 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.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$3,400
Primary doctor visit
$0 copay
Specialist visit
$30 copay per visit
ER visit
$110 copay per visit (always covered)
Ambulance
$270 copay

Essence Advantage Choice (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,400 In and Out-of-network $3,400 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 Choice (PPO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Essence Advantage Choice (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 Choice (PPO) includes coverage for hearing, vision, dental.

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

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
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

Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,400 In and Out-of-network
$3,400 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: $15 copay per visit
Specialist visit
In-network: $30 copay per visit
Out-of-network: $30 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0-30 copay
Out-of-network: $0-30 copay
Lab services
In-network: $0 copay
Out-of-network: 40% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0-200 copay
Out-of-network: $0-200 copay
Outpatient x-rays
In-network: $15 copay
Out-of-network: $15 copay
Emergency care
$110 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $290 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $290 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
In-network: $280 copay per visit
Out-of-network: $280 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$170 per day for days 21 through 100
Out-of-network: 40% per stay

Preventive services

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

Ambulance

Ground ambulance
In-network: $270 copay
Out-of-network: $270 copay

Therapy services

Occupational therapy visit
In-network: $40 copay
Out-of-network: $40 copay
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: $40 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: 20% coinsurance per item
Out-of-network: 40% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay
Out-of-network: 0-20% coinsurance per item

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$4.00 copay$4.00 copay


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$12.00 copay$12.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 0-40% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 0-40% coinsurance

Hearing

Hearing exam
In-network: $20 copay
Out-of-network: $20 copay
Fitting/evaluation
In-network: $0 copay
Out-of-network: $20 copay
Hearing aids - All types
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Extractions
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: $0 copay
Contact lenses
In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: $0 copay
Upgrades
In-network: $15-65 copay or 80-90% coinsurance
Out-of-network: $0 copay

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