Essence Advantage Premier Plus (PPO)

by Essence Healthcare

2027 Medicare Advantage plan available in Missouri

Plan ID H6200-008-0

Additional coverage:

RxHearing

Medicare Advantage PPO

Monthly plan premium $264 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $2,900 / yr

Drug deductible $700 / yr

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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 Missouri 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 $264 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $2,900. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $264 / mo

Health portion of premium $183

Drug portion of premium $81

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $2,900 / 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

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:
  Tier 1
  $300 per day for days 1-7
  $0 per day for days 8-90
  $0 per stay
Out-of-network:
  $300 per day for days 1-7
  $0 per day for days 8-90
  $0 per stay

Outpatient hospital coverage In-network: $0 copay
Out-of-network: $0 copay

Skilled nursing facility

Skilled nursing facility In-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 drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic $10.00 copay $0 copay

Generic $15.00 copay $0 copay

Preferred Brand 25% coinsurance $0 copay

Non-Preferred Drug 27% coinsurance $0 copay

Specialty Tier 25% 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 - prescription In-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

Plan details (carrier site)Provider directory Drug list (formulary)

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