Essence Advantage (HMO)

Essence Advantage (HMO) is a HMO plan offered by Lumeris Group Holdings Corporation available for enrollment in 2025 to people living in Southwest Missouri and Northwest/Central Arkansas. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that Essence Advantage (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Essence Advantage (HMO).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Essence Advantage (HMO) plan offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $340.00. During the initial coverage phase, copays for a 30-day supply of Tier 1 preferred generics start at $3.00 at preferred pharmacies, while Tier 2 standard generics and Tier 3 preferred brands require higher copays up to $100.00 depending on the pharmacy type. Tier 4 non-preferred drugs carry a 29% coinsurance, and Tier 5 specialty drugs are available with no copay. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy, or Extra Help, can benefit from a reduced Part D premium of $0.00.

Additional Benefits

Essence Advantage (HMO) offers predictable cost-sharing with no coinsurance for many core medical services, including inpatient hospital stays, outpatient care, and emergency services. Primary care doctor visits range from no copay up to $40, while emergency room visits require a $150 copay that is waived if you are admitted within 24 hours. For inpatient acute care, members pay a $275 daily copay for days 1 through 5, with no copay for days 6 through 90. This plan also provides valuable supplemental coverage, including preventive and comprehensive dental services with no copay, which covers cleanings and orthodontic services up to $925 annually. Members also receive a $200 annual eyewear allowance and a $1,000 hearing aid allowance every two years with no copay. Additionally, the plan includes a $50 over-the-counter reimbursement every three months with no copay, though some items like durable medical equipment require a 20% coinsurance.