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Essence Advantage Premier Plus (PPO)

H6200 - 008 - 0

(4 / 5)

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

This page features plan details for 2025 Essence Advantage Premier Plus (PPO) H6200 – 008 – 0 available in St. Louis Metropolitan Area.

Locations

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

Bond County, Illinois

Clinton County, Illinois

Crawford County, Missouri

Click to see more locations

Plan Overview

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

Insurer:	Essence Healthcare
Health Plan Deductible:	$0
MOOP:	$1,000 In and Out-of-network $1,000 In-network
Drugs Covered:	Yes

Ready to sign up for Essence Advantage Premier Plus (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 Premier Plus (PPO) has a monthly premium of $247.00. 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	$222.60	$24.40	$	$

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

Drug Deductible:	$590.00
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 D	LIS Full
$24.40	$0.00

Initial Coverage Phase

After you pay your $590.00 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.

30 Day

60 Day

90 Day

30 Day

Tier	Pref. Pharm	Std. Pharm
1) Preferred Generic		$15.00 Copay
2) Generic	$3.00 Copay	$20.00 Copay
3) Preferred Brand	$47.00 Copay	$47.00 Copay
4) Non-Preferred Drug	46.00% Coinsurance	46.00% Coinsurance
5) Specialty Tier	25.00% Coinsurance	25.00% Coinsurance

60 Day

Tier	Pref. Pharm	Std. Pharm
1) Preferred Generic		$30.00 Copay
2) Generic	$6.00 Copay	$40.00 Copay
3) Preferred Brand	$94.00 Copay	$94.00 Copay
4) Non-Preferred Drug	46.00% Coinsurance	46.00% Coinsurance
5) Specialty Tier

90 Day

Tier	Pref. Pharm	Std. Pharm	Std. Mail
1) Preferred Generic		$45.00 Copay
2) Generic	$9.00 Copay	$60.00 Copay	$7.50 Copay
3) Preferred Brand	$141.00 Copay	$141.00 Copay	$117.50 Copay
4) Non-Preferred Drug	46.00% Coinsurance	46.00% Coinsurance
5) Specialty Tier

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 Premier Plus (PPO) also provides the following benefits.

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

- In-Network: No

Diagnostic procedures/lab services/imaging

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

Doctor visits

Primary
- Out-of-Network: $0 copay
- In-Network: $0 copay
Specialist
- In-Network: $0 copay (Authorization Required)
- Out-of-Network: $0 copay (Authorization Required)

Emergency care/Urgent care

Urgent care
- $0 copay
Emergency
- $0 copay

Foot care (podiatry services)

Foot exams and treatment
- In-Network: $0 copay
Routine foot care
- Not covered
Foot exams and treatment
- Out-of-Network: $0 copay

Ground ambulance

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

Inpatient hospital coverage

- Out-of-Network: $500 per stay (Authorization Required)
- In-Network: $500 per stay (Authorization Required)

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

- $1,000 In and Out-of-network
  $1,000 In-network

Medical equipment/supplies

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

Medicare Part B drugs

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

Mental health services

Outpatient group therapy visit
- Out-of-Network: $0 copay
Outpatient group therapy visit with a psychiatrist
- Out-of-Network: $0 copay (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- In-Network: $0 copay (Authorization Required)
- Out-of-Network: $0 copay (Authorization Required)
Inpatient hospital – psychiatric
- In-Network: $500 per stay (Authorization Required)
- Out-of-Network: $500 per stay (Authorization Required)
Outpatient group therapy visit
- In-Network: $0 copay
Outpatient individual therapy visit
- In-Network: $0 copay
Outpatient group therapy visit with a psychiatrist
- In-Network: $0 copay (Authorization Required)
Outpatient individual therapy visit
- Out-of-Network: $0 copay

Optional supplemental benefits

- No

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- In-Network: $0 copay (Authorization Required)
- Out-of-Network: $0 copay (Authorization Required)

Preventive care

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

Rehabilitation services

Physical therapy and speech and language therapy visit
- In-Network: $0 copay
Occupational therapy visit
- In-Network: $0 copay
- Out-of-Network: $0 copay
Physical therapy and speech and language therapy visit
- Out-of-Network: $0 copay

Skilled Nursing Facility

- In-Network: $0 copay (Authorization Required)
- Out-of-Network: $0 copay (Authorization Required)

Transportation

- Not covered

Vision

Contact lenses
- Not covered
Eyeglass frames
- Not covered
Routine eye exam
- Not covered
Eyeglasses (frames and lenses)
- Not covered
Other
- Not covered
Upgrades
- Not covered
Eyeglass lenses
- Not covered

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

- Covered (Authorization Required)