2027 Medicare Advantage plan

Essence Advantage (HMO): 2027 benefits and costs

Essence Healthcare HMO

CMS plan ID: H2610-015-0 · Plan year: 2027

Essence Advantage (HMO) is a 2027 Medicare Advantage plan offered by Essence Healthcare. It is listed in Arkansas, Missouri.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$450.00

In-network medical out-of-pocket maximum$4,000.00

Organization: Essence Healthcare
Plan organization: ESSENCE HEALTHCARE, INC.
Parent company: Lumeris Group Holdings Corporation
Plan type: HMO
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $4,000.00
Applies to certain in-network supplemental services.

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0 Service-specific deductible No
Specialist visit	$0.00 to $20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Telehealth	$0.00 to $40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Emergency care	$150.00 copay
Urgent care	$45.00 copay
Home health	$0 Service-specific deductible No	Approval required No Referral required No
Dialysis	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered foot care	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Other health professionals	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–5: $325.00 copay per day Days 6–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–5: $325.00 copay per day Days 6–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $160.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$325.00 copay Service-specific deductible No
Hospital observation services	$325.00 copay Service-specific deductible No
Ambulatory surgical center	$220.00 copay Service-specific deductible No	Approval required Yes Referral required No
Outpatient blood	$0 Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0.00 to $35.00 copay Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	$5.00 copay Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	$0.00 to $200.00 copay Service-specific deductible No	Approval required Yes Referral required No
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
X-rays	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$0 Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	$0 Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, group sessions	$10.00 copay Service-specific deductible No	Approval required Yes Referral required No
Opioid treatment program	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Mental health, individual sessions	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Mental health, group sessions	$10.00 copay Service-specific deductible No	Approval required No Referral required No
Psychiatry, individual sessions	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, group sessions	$10.00 copay Service-specific deductible No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Physical and speech therapy	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Cardiac rehabilitation	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Intensive cardiac rehabilitation	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Pulmonary rehabilitation	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	$20.00 copay Service-specific deductible No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$250.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	$250.00 copay Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	$0 Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic monitors	$0 Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$20.00 copay
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
FluorideAdditional plan benefit	$0
Restorative dental careAdditional plan benefit	$0
Root canal treatment (endodontics)Additional plan benefit	$0
Gum treatment (periodontics)Additional plan benefit	$0
Removable dentures (prosthodontics)Additional plan benefit	$0
Maxillofacial prostheticsAdditional plan benefit	$0
Dental implantsAdditional plan benefit	$0
Fixed dental restorations (prosthodontics)Additional plan benefit	$0
Oral surgeryAdditional plan benefit	$0
OrthodonticsAdditional plan benefit	$0
Other dental servicesAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$20.00 copay	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Flex Card

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Oral Exams; Dental X-Rays; Dental cleaning; Fluoride Treatment; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Maxillofacial Prosthetics; Implant Services; Fixed dental restorations (prosthodontics); Oral and Maxillofacial Surgery; Orthodontics; Adjunctive General Services; Routine Eye Exams; Contact Lenses; Eyeglasses (lenses and frames); Eyeglass lenses; Eyeglass frames; Routine Hearing Exams; Hearing aid fitting and evaluation; Prescription Hearing Aids (all types)
How benefits are provided: Debit Card
Advance choice of benefits required: No
Shared benefit limit: $2,000.00
How often this limit applies: Every year
Shared limit on visits or trips: No

Benefits for qualifying members

Diabetic Eye Exam

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Diabetes
Covered package services cost $0 until the package limit is reached: No
Benefits that apply to reduced cost sharing: Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing: Eye exams (category)
Some package benefits are exempt from the deductible: No
Do you offer reduced Coinsurance?: No
Service-specific deductible: No
Reduced Copayment?: Yes
Types of benefits that apply to the copayment cost sharing: Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment: Eye exams (category)
Minimum Copayment for Eye Exams: $0.00
Maximum Copayment for Eye Exams: $0.00

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	90 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$3.00	$6.00	$9.00
Tier 3Preferred Brand	$45.00	$90.00	$135.00
Tier 4Non-Preferred Drug	$95.00	$190.00	$285.00
Tier 5Specialty Tier	28%	Not listed	Not listed

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	90 days
Tier 1Preferred Generic	$5.00	$10.00	$15.00
Tier 2Generic	$10.00	$20.00	$30.00
Tier 3Preferred Brand	$47.00	$94.00	$141.00
Tier 4Non-Preferred Drug	$100.00	$200.00	$300.00
Tier 5Specialty Tier	28%	Not listed	Not listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	90 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$3.00	$6.00	$6.00
Tier 3Preferred Brand	$45.00	$90.00	$90.00
Tier 4Non-Preferred Drug	$95.00	$190.00	$190.00
Tier 5Specialty Tier	28%	Not listed	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$5.00
Tier 2Generic	$10.00
Tier 3Preferred Brand	$47.00
Tier 4Non-Preferred Drug	$100.00
Tier 5Specialty Tier	28%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$5.00
Tier 2Generic	$10.00
Tier 3Preferred Brand	$47.00
Tier 4Non-Preferred Drug	$100.00
Tier 5Specialty Tier	28%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Both Part D and Excluded Drugs
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 2 states or territories. Availability can vary by county and ZIP code.

View all locations 29 county listings across 2 states or territories