There are three basic ways in which you can take your Medicare benefits.First, is the simplest one- enroll into Original Medicare, Part A and Part B to get your hospitalization and outpatient expenses covered. You may or may not add a supplemental plan to cover the out-of-pocket expenses. Second, along with Part A and B you can get Part D to get prescription drug coverage. Third, you can buy a Medicare Advantage plan which will give you all the benefits under Original Medicare along with prescription drug coverage.
Medicare Advantage plans have to be bought from private insurance companies which serve the area in which you live. People living in the states of Missouri and Illinois can consider Essence Healthcare while shopping for a Medicare Advantage plan.
Medicare Advantage Plan from Essence
Essence offers Medicare Advantage HMO plans to specific counties in Missouri and Illinois. All the plans include prescription drug coverage.The plans are sold as Essence Advantage and Essence Advantage Plus. You have to be entitled to receive Medicare Part A benefits and be enrolled into Part B in order to buy these plans. You also have to continue paying the Part B premiums even if you buy Medicare Advantage plans.
Features of Essence Medicare Advantage Plans
- Since these are HMO plans, members have to stay within the network of providers to get coverage.
- The care is coordinated through a primary care physician who helps to guide and take decisions regarding treatments
- Members need the approval of the primary care physician if they have to consult specialists
- Members have to get their prescription filled at the network pharmacies
- Essence Advantage has no monthly premiums, for Advantage Plus you have to pay a premium of $79. Both plans do not have any deductible
- Maximum out-of-pocket expense limit for Essence Advantage and Advantage Plus is $2500 and $2300 respectively for covered hospital and medical services taken through network providers
- The benefits are same for both the plans,the difference lies in the amounts of copays and coinsurance amounts
- Some coverage for hearing exams, vision care including eye glasses, routine dental exams and dentist visits. Hearing aids are not covered.
- Other benefits include – mental health services, physical therapy, skilled nursing facility, ambulance service, transportation, chiropractic care for specific problems, diabetes service and supplies, medical equipment, home health care, health club membership and fitness programs
- Hospice care costs will still be taken care of by Medicare Part A
Essence offers different ways for you to get detailed information about their plans. You can attend one of the local meetings or visit their Medicare learning center. You can also request an information kit.