Essence Healthcare

What the CMS Data Shows About Essence Healthcare

Essence Healthcare is registered with the Centers for Medicare & Medicaid Services as a Medicare Advantage Organization and, in the 2026 contract year, markets 22 distinct plans across 5 states and 72 counties. The contracts sit inside the Lumeris Group Holdings Corporation corporate family, which matters for quality measurement because CMS aggregates many Star Rating measures at the parent-organization level before applying the contract-level bonus payment rules. CMS-reported enrollment across this issuer's MA plans is not disclosed in the public file for the 2026 plan year, a figure drawn from the same Monthly Enrollment by Contract/Plan/State/County Report used by Medicare researchers.

On quality, Essence Healthcare carries a weighted mean CMS Star Rating of 3.96 out of 5 across its Medicare Advantage book, with 0 contracts earning the top 5-star tier. The star score is not a marketing claim — it is a composite CMS calculates from more than 40 individual measures spanning preventive care delivery, chronic-condition management, patient safety, member-experience surveys (CAHPS), appeals handling, and plan-operations metrics. Contracts above 4 stars trigger federal Quality Bonus Payments, a rebate mechanism that insurers typically re-invest into supplemental benefits such as dental, vision, hearing, over-the-counter allowances, and fitness programs — which is why two plans from the same issuer can look very different on extras depending on which contract they fall under.

The product mix shown below — HMO, Local PPO, HMO POS — determines how beneficiaries access care. HMO plans keep cost-sharing low but lock to in-network providers; local and regional PPOs relax that at higher copays; and Special Needs Plans (SNPs) add disease-specific formulary and care-management features for chronic conditions, duals, or institutional residents. Before enrolling, verify that Essence Healthcare's plan is offered in your specific county, that your preferred providers are in network, and that your prescriptions appear on the plan's current formulary. All figures on this page originate from CMS public-use files for the 2026 contract year and are informational only, not Medicare counseling advice.