Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Essence Advantage Choice, 2027

H6200Contract001Plan

PPO · 20 counties in Illinois, Missouri

Run by Essence Healthcare PPO, Inc. (contract H6200), sold as Essence Healthcare, owned by Lumeris Group Holdings Corporation

Renews for 2027

2026 star rating, contract H6200: 3.5 of 5

Essence Advantage Choice (H6200-001) costs $40 a month in 2027, up $40 from 2026, with an in-network out-of-pocket limit of $9,850 ($5,400 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
Monthly premium	$0	$40	up $40
In-network out-of-pocket limit	$5,400	$9,850	up $4,450
Drug deductible	$340	$700	up $360
Specialist visit	$40 copay	$0 copay	down $40
Emergency room	$130 copay	$115 copay	down $15
Medical deductible, in network	none	$260	added
Skilled nursing facility, in network	$0 a day for days 1–20, then $170 a day for days 21–100	$0 a day for days 1–20, then $220 a day for days 21–100	up $500for a 30-day stay
Eyewear, yearly limit	$200 a year	$175 a year	down $25
Drug tier 2, generic	$12	$15	up $3
Drug tier 3, preferred brand	$47	25% of the cost	changed
Drug tier 4, non-preferred drug	50% of the cost	25% of the cost	down 25 points
Drug tier 5, specialty tier	29% of the cost	25% of the cost	down 4 points
9 lines do not change
Part B premium reduction, monthly	none	none	no change
Primary care visit	$0 copay	$0 copay	no change
Hospital stay, in network	$330 a day for days 1–7, then $0 a day for days 8–90	$330 a day for days 1–7, then $0 a day for days 8–90	no change
Ground ambulance, in network	$270 copay	$270 copay	no change
Comprehensive dental, yearly limit	not offered	not offered	no change
Hearing aids, yearly limit for both ears	$500 a year	$500 a year	no change
Over-the-counter items, yearly	not offered	not offered	no change
Counties served	20	20	no change
Drug tier 1, preferred generic	$4	$4	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked. The plan charges less at its preferred pharmacies
Tier	What the tier holds	2026, standard pharmacy	2027, standard pharmacy	2027, preferred pharmacy
Tier 1	Preferred Generic	$4	$4	$0
Tier 2	Generic	$12	$15	$5
Tier 3	Preferred Brand	$47	25% of the cost	25% of the cost
Tier 4	Non-Preferred Drug	50% of the cost	25% of the cost	25% of the cost
Tier 5	Specialty Tier	29% of the cost	25% of the cost	25% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 68 plans open to everyone are sold for 2027, this one included. Against the others, 64 plans have a lower out-of-pocket limit, 3 the same. On the premium, 55 plans have a lower premium, 12 a higher one.

Out-of-pocket limits of the 68 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0007 plans

$4,000 to under $6,00035 plans

$6,000 to under $8,00021 plans

$8,000 to $10,000 (this plan)5 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 20 counties: $40 a month and $9,850.

Illinois

Bond Clinton Jersey Macoupin Madison Monroe St. Clair

Missouri

Boone Callaway Crawford Franklin Gasconade Jefferson Lincoln Montgomery St. Charles St. Louis St. Louis City Warren Washington

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H6200-001
Legal name of the contract: Essence Healthcare PPO, Inc.
Sold as: Essence Healthcare
Parent company: Lumeris Group Holdings Corporation
Plan type: PPO
2026 star rating of the contract: 3.5 of 5 overall; health plan 3.5 of 5, drug plan 3 of 5
Members, September 2026: 8,302
Plan website, as filed with CMS: www.essencehealthcare.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in St. Louis, MOWhere most of its members live; premiums and limits side by side
Every Essence Healthcare plan for 2027Its contracts, counties and plans that end
The other 6 plans of contract H6200Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.