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Essence Advantage Choice (PPO)

H4620 - 001 - 0
Plan Not Rated

Essence Advantage Choice (PPO) is a Medicare Advantage Plan by Essence Healthcare.

This page features plan details for 2025 Essence Advantage Choice (PPO) H4620 – 001 – 0 available in OH- Brown Butler Clermont Clinton Hamilton Warren.

Locations

Essence Advantage Choice (PPO) is offered in the following locations.

Brown County, Ohio
Butler County, Ohio
Clermont County, Ohio

Click to see more locations

Plan Overview

Essence Advantage Choice (PPO) offers the following coverage and cost-sharing.

Insurer:Essence Healthcare
Health Plan Deductible:$0
MOOP:$6,900 In and Out-of-network
$4,900 In-network
Drugs Covered:Yes

Ready to sign up for Essence Advantage Choice (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Essence Advantage Choice (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Essence Advantage Choice (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Essence Advantage Choice (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: Yes, contact plan for further details

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Implant Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Orthodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Fluoride Treatment
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Oral Exams
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-200 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-30 copay (Authorization Required)
    • Out-of-Network: $0-30 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: $30 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $0-200 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $30 copay (Authorization Required)

Doctor visits

  • Primary
    • Out-of-Network: $15 copay per visit
  • Specialist
    • In-Network: $30 copay per visit (Authorization Required)
  • Primary
    • In-Network: $0 copay
  • Specialist
    • Out-of-Network: $30 copay per visit (Authorization Required)

Emergency care/Urgent care

  • Urgent care
    • $45 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $30 copay
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: $30 copay

Ground ambulance

    • In-Network: $290 copay
    • Out-of-Network: $290 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: $20 copay
    • In-Network: $20 copay
  • Hearing aids
    • Out-of-Network: $0 copay (Limits Apply)
  • Fitting/evaluation
    • Out-of-Network: $0 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • In-Network: $375 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: $375 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $6,900 In and Out-of-network
      $4,900 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 40% coinsurance per item (Authorization Required)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 0-20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Other Part B drugs
    • Out-of-Network: 40% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 40% coinsurance (Authorization Required)
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: $10-15 copay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $15 copay
    • Out-of-Network: $10-15 copay
  • Outpatient group therapy visit
    • In-Network: $10 copay
    • Out-of-Network: $10-15 copay
  • Inpatient hospital – psychiatric
    • In-Network: $375 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • Out-of-Network: $375 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $10 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $15 copay (Authorization Required)
    • Out-of-Network: $10-15 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: $325 copay per visit (Authorization Required)
    • In-Network: $325 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: $35 copay
  • Physical therapy and speech and language therapy visit
    • In-Network: $35 copay
  • Occupational therapy visit
    • In-Network: $35 copay
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $35 copay

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $184 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: 40% per stay (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered (Authorization Required)

Ready to sign up for Essence Advantage Choice (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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