Essence Rx (HMO-POS) Medicare Advantage Plan H5211-002 • 2026 • Chippewa County, WI

Essence Rx Overview

Plan Overview for Essence Rx

This Medicare Advantage MAPD HMO-POS plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $87.00, and the plan provides coverage through a network of participating providers, with limited access to out-of-network services in certain situations. The annual Part D deductible is $330.00.

Primary care visits have a $0 copay | Out-of-network: $0 copay, 0% coinsurance, specialist visits come with a $50 copay | Out-of-network: $50 copay, urgent care services carry a $0-$50 copay, and ambulance transportation is $225 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $3800.00. After this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H5211-002. Cost-sharing details for key services are provided below.

Cost Sharing Expenses

Cost-sharing for Essence Rx includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H5211-002.

Certain preventive services are covered 100% by Essence Rx as a Part B benefit.

Prescription Drug Coverage

Essence Rx includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $330.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Security Health Plan of Wisconsin, Inc. starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Essence Rx may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

CMS 5-Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.