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Important Disclaimer

Essence Healthcare is an HMO plan with a Medicare contract. Essence Healthcare also includes an HMO D-SNP plan with a contract with Medicare and the state Medicaid program. Enrollment in Essence Healthcare depends on contract renewal. All Essence Healthcare plans include Part D drug coverage.

To enroll in an Essence Healthcare plan, you must have both Medicare Parts A and B and reside in the plan service area. You must have both Medicare Parts A and B and medical assistance from the Missouri Medicaid program with QMB and QMB Plus eligibility to enroll in an Essence Healthcare HMO D-SNP plan. You must continue to pay your Medicare Part B premium. Enrollment in an Essence Healthcare plan may be limited to specific times of the year.

Members enrolled in an Essence Healthcare HMO or HMO D-SNP plan must use plan providers except in emergency or urgent care situations. If a member obtains routine care from an out-of-network provider without prior approval from Essence Healthcare, neither Medicare, Medicaid, nor Essence Healthcare will be responsible for the costs.

Members enrolled in an Essence Healthcare HMO-POS or PPO plan may see out-of-network providers (non-contracted providers). Out-of-network providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

For more information or assistance, please call Customer Service at the number listed under the Contact Us page. Language assistance services are available, free of charge.

Every year, Medicare evaluates plans based on a 5-star rating system.

Benefits, star ratings, and network may vary by plan, contract, or market. Please refer to plan documents for additional information or contact Customer Service.

Essence Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Y0027_22-951_C - Last Updated Date: 12/01/2022

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