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Essence Advantage Premier Plus (PPO)

Health Insurance Company: Essence Healthcare

Medicare Advantage Plan Details

Essence Healthcare
$247 /mo
monthly premium
Essence Advantage Premier Plus (PPO)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Hearing
4
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$1000
Rx Drug Coverage
Yes
Rx Deductible
$590
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$0 copay

Additional Benefits

Dental Coverage
No
Vision Coverage
No
Mental Health Coverage
Yes
Transportation for non-emergency
No
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $0 copay
Out-of-network: $0 copay
Specialist Office Visit
In-network: $0 copay
Out-of-network: $0 copay
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: $0 copay

Emergency Room

$0 copay

Ambulance Coverage

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

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0 copay
Out-of-network: $0 copay
Medicare-covered lab services: In-network: $0 copay
Out-of-network: $0 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0 copay
Out-of-network: $0 copay
Medicare-covered x-ray services: In-network: $0 copay
Out-of-network: $0 copay

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0 copay
Out-of-network: $0 copay

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $500 per stay
Out-of-network: $500 per stay
Inpatient hospital psychiatric:
In-network: $500 per stay
Out-of-network: $500 per stay

Rehabilitation Coverage

Occupational therapy services:
In-network: $0 copay
Out-of-network: $0 copay
Physical therapy and speech and language therapy services:
In-network: $0 copay
Out-of-network: $0 copay

Urgent Care Coverage

$0 copay

Skilled Nursing Facility (SNF)

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

Mental Health Coverage

Medicare-covered individual sessions: In-network: $0 copay
Out-of-network: $0 copay
Medicare-covered group sessions: In-network: $0 copay
Out-of-network: $0 copay

Dental, Vision, Hearing Benefits

Vision Benefits

Eye exams:
Routine eye exams: Not covered
Eyewear:
Contact Lenses: Not covered
Eyeglasses: Not covered

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $0 copay
Out-of-network: $0 copay
Hearing aids:
Hearing aids (all types): In-network: $0 copay
Out-of-network: $0 copay

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$3.00 copay (30-day supply)
$9.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

46% coinsurance (30-day supply)
46% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$15.00 copay (30-day supply)
$45.00 copay (90-day supply)

Tier 2: Generic

$20.00 copay (30-day supply)
$60.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

46% coinsurance (30-day supply)
46% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

Tier 1: Preferred Generic

$0.00 copay (90-day supply)

Tier 2: Generic

$7.50 copay (90-day supply)

Tier 3: Preferred Brand

$117.50 copay (90-day supply)

Tier 4: Non-Preferred Drug

46% coinsurance (90-day supply)

Tier 5: Specialty Tier

25% coinsurance (30-day supply)

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
No
Acupuncture
No
Massage Therapy
No
Health Education
No
Counseling Services
No
Support for Caregivers of Enrollees
No
Personal Emergency Response System (PERS)
No
In-home support services
No
Home and bathroom safety devices
No
Meals for short duration
No

Plan Links

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Where This Plan is Available

State:
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Additional Plan Info

Plan Year:
2025
Insurance Company Website:
Essence Healthcare

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint