ZIP Code
County

Apply For This Plan

Zip Code	60629
Applicant	11/20/1983 Male
Coverage Start	11/21/2018

Insurance Type	Medicare Advantage Plan (Part C w/ RX)
Insurance Provider	Essence HealthCare
Plan ID	H2610-5-0
Plan Year	2018
CMS Rating
Plan Type	HMO
Annual Deductible	$0.00

What To Know About This Plan	This plan has health and drug coverage This plan is available for 2019. see plan

Why We Like This Plan	has both Health and Drug Coverage has no additional premium costs outside of your Medicare Part B premium has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies) was the 3rd best selling plan in Cook in 2019

Costs and Other Important Information

Plan Year	2018
Optional Supplemental Benefits	No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$2,500 In-network
Other health plan deductibles?	No
Health Plan Deductible	$0
Monthly Drug Plan Premium	$0.00
Monthly Health Plan Premium	$0.00

Benefits

SERVICE	COST
Inpatient hospital coverage	$265 for days 1 through 9 $0 for days 10 through 90
Outpatient hospital coverage	$250 or 20% per visit
Doctor visits	Primary: $5 per visit Specialist: $40 per visit
Preventive care	$0 copay
Emergency care/Urgent care	Emergency: $100 per visit (always covered) Urgent care: $35 per visit (always covered)
Diagnostic procedures/lab services/imaging	Diagnostic tests and procedures: 20% Lab services: $0 copay Diagnostic radiology services (e.g., MRI): 20% Outpatient x-rays: $20
Mental health services	$250 for days 1 through 7 $0 for days 8 through 90 Outpatient group therapy visit with a psychiatrist: $25 Outpatient individual therapy visit with a psychiatrist: $35 Outpatient group therapy visit: $25 Outpatient individual therapy visit: $35
Skilled Nursing Facility	$20 for days 1 through 20 $125 for days 21 through 100
Rehabilitation services	Occupational therapy visit: $30 Physical therapy and speech and language therapy visit: $30
Ambulance	$220
Transportation	$0 copay
Foot care (podiatry services)	Foot exams and treatment: $40 Routine foot care: Not covered
Medical equipment/supplies	Durable medical equipment (e.g., wheelchairs, oxygen): 20% per item Prosthetics (e.g., braces, artificial limbs): 20% per item Diabetes supplies: $0 copay
Wellness programs (e.g., fitness, nursing hotline)	Covered
Medicare Part B drugs	Chemotherapy: 20% Other Part B drugs: 20%

Coverage Area for Essence Advantage (HMO)

State	Illinois
County	Cook

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	$0 copay	$4 copay	Not offered
Tier 2: Non-Preferred Generic	$0 copay	$12 copay	Not offered
Tier 3: Preferred Brand Name	$39 copay	$47 copay	Not offered
Tier 4: Non-Preferred Brand Name	$75 copay	$100 copay	Not offered
Tier 5: Specialty Tier	33% coinsurance	33% coinsurance	Not offered

60 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	$0 copay	$8 copay	Not offered
Tier 2: Non-Preferred Generic	$0 copay	$24 copay	Not offered
Tier 3: Preferred Brand Name	$78 copay	$94 copay	Not offered
Tier 4: Non-Preferred Brand Name	$150 copay	$200 copay	Not offered
Tier 5: Specialty Tier

90 Day Supply	Preferred Retail Pharmacies	Non-Preferred Retail Pharmacies	Mail-Order Pharmacies
Tier 1: Preferred Generic	$0 copay	$12 copay	Not offered
Tier 2: Non-Preferred Generic	$0 copay	$36 copay	Not offered
Tier 3: Preferred Brand Name	$117 copay	$141 copay	Not offered
Tier 4: Non-Preferred Brand Name	$225 copay	$300 copay	Not offered
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management	Not Rated
Care for older adults – medication review	Not Rated
Care for older adults – functional status assessment	Not Rated
Care for older adults – Pain screening	Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physicians that accept Essence Advantage (HMO) for Illinois

Last Name

Location/Distance

Please select the correct zip

Bozzano, Anthony

View All Details

Calero, Eleazar

View All Details

Agrawal, Shri

View All Details

Labanauskas, Ignas

View All Details

Wong, Alton

View All Details

Ulaszek, David

View All Details

Mcdonnell, Michael

View All Details

Sagan-blausius, Anna

View All Details

Memmel, Lisa

View All Details

Stulberg, Debra

View All Details

Ahuja, Satya

View All Details

Tatka, Keith

View All Details

Bender, Jessica

View All Details

Brahmbhatt, Nimeet

View All Details

Ballany, Wassim

View All Details

Mcgrail, Michael

View All Details

Patel, Amishi

View All Details

Mamdani, Salman

View All Details

Spear, William

View All Details

Ybanez, Neil

View All Details

Nouneh, Chadi

View All Details

Khilfeh, Hamdi

View All Details

Sethi, Romi

View All Details

Wohlberg, Frederick

View All Details

Mularczyk, Joseph

View All Details

Anthony Bozzano, MD

View All Details

Phone Number
(773) 735-3456
Office Locations
6449 So Pulaski Road
Chicago, IL 60629

6449 So Pulaski Road Chicago IL, 60629

HumanaChoice H5216-012 (PPO)
COST:from $0	CMS Rating:

Health Alliance Medicare HMO Basic (HMO)
COST:from $0	CMS Rating:

Cigna-HealthSpring Advantage (HMO)
COST:from $0	CMS Rating:

MeridianCare Essential (HMO)
COST:from $0	CMS Rating:

HealthPartners UnityPoint Health Align (PPO)
COST:from $0	CMS Rating:Not Rated

get free advice

Speak With A Licensed Agent

Call (800) 931-6467

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

ZIP Code
County

Medicare Plans Found

Sort by

Sorry, there are no medicare plan available in your area.

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.