Essence (HMO-POS)
H5211 - 003 - 0
(4 / 5)
Essence (HMO-POS) is a Medicare Advantage Plan by Security Health Plan of Wisconsin, Inc..
This page features plan details for 2024 Essence (HMO-POS) H5211 – 003 – 0 available in Central, North, Northeast, West & South Central WI.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
Locations
Essence (HMO-POS) is offered in the following locations.
Plan Overview
Essence (HMO-POS) offers the following coverage and cost-sharing.
| Insurer: | Security Health Plan of Wisconsin, Inc. |
| Health Plan Deductible: | $0.00 |
| MOOP: | $3,400 In and Out-of-network $3,400 In-network $3,400 Out-of-network |
| Drugs Covered: | No |
Ready to sign up for Essence (HMO-POS) ?
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 (HMO-POS) has a monthly premium of $20.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $20.00 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Essence (HMO-POS) also provides the following benefits.
| $0 |
| In-network | Yes |
| $3,400 In and Out-of-network $3,400 In-network $3,400 Out-of-network |
| Yes |
| In-network | Yes, contact plan for further details |
| In-network | $0-200 copay per visit (Authorization is required.) (Referral is not required.) |
| out-of-network | $0-200 copay per visit (Authorization is required.) (Referral is not required.) |
| In-network Primary | $0 copay (Not applicable.) (Not applicable.) |
| out-of-network Primary | $0 copay (Not applicable.) (Not applicable.) |
| In-network Specialist | $50 copay per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network Specialist | $50 copay per visit (Authorization is not required.) (Referral is not required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $125 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $0-50 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | $5 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic tests and procedures | $5 copay (Authorization is required.) (Referral is not required.) |
| In-network Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | $200 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | $200 copay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient x-rays | $5 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient x-rays | $5 copay (Authorization is required.) (Referral is not required.) |
| In-network Hearing exam | $50 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing exam | $50 copay (Authorization is not required.) (Referral is not required.) |
| In-network Fitting/evaluation | $50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Fitting/evaluation | $50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| In-network Hearing aids | $500 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Routine eye exam | $0-50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Routine eye exam | $0-50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| In-network Other | $0-50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Other | $0-50 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| In-network Occupational therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Occupational therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Physical therapy and speech and language therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
| In-network | $200 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| In-network Foot exams and treatment | $50 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Foot exams and treatment | $50 copay (Authorization is not required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
| Covered (Authorization is required.) (Referral is not required.) |
| In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network | $300 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| out-of-network | $300 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | $300 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | $300 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| In-network | $0 per day for days 1 through 6 $20 per day for days 7 through 45 $0 per day for days 46 through 100 (Authorization is required.) (Referral is not required.) |
| out-of-network | $0 per day for days 1 through 6 $20 per day for days 7 through 45 $0 per day for days 46 through 100 (Authorization is required.) (Referral is not required.) |
| Monthly Premium | $43.00 |
| Deductible | $100.00 |
Optional Benefits
Package #1
| Preventive dental: | Monthly Premium: | $43.00 |
| Preventive dental: | Deductible: | $100.00 |
| Comprehensive dental: | Monthly Premium: | $43.00 |
| Comprehensive dental: | Deductible: | $100.00 |
Ready to sign up for Essence (HMO-POS) ?
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
Table of Contents
Need more information on Essence (HMO-POS)? See 2025 Essence (HMO-POS) at MedicareAdvantageRX.com.
Get Help Enrolling
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
SMID: MULTIPLAN_HCIHNDOGMED01PY25_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
Medicare has neither approved nor endorsed any information on this site.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period.
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.