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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.

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

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: 09/08/2022

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