How to Enroll in an Essence Plan

Enroll Online

enroll online icon You can enroll right away by using our secure online enrollment system. It is very easy to use, and it will walk you through the process step by step. It takes just about 5 to 10 minutes to complete. Once you complete and submit the electronic enrollment form, you will be submitting an official application to join an Essence plan. To get started, click the “Enroll Online” button below.

Enroll Over the Phone

phone icon Enrolling over the phone is quick and easy and takes just a few minutes. Call us toll free at 1-866-509-5398 (TTY 711) and one of our Medicare experts will be happy to guide you through the enrollment process and answer any questions you may have.

Telephone lines are open 8 a.m. to 8 p.m., seven days a week. You may receive a messaging service on weekends and holidays from February 15 through September 30. If that happens, simply leave a message and your call will be returned the next business day.

Enroll by Mail

enroll by mail icon You can request a free information kit that provides you with more details about our plans and includes easy-to-follow instructions on how to enroll. You can also download an enrollment form using the link below.  Once you complete the enrollment form, you can return it via the postage paid envelope included with the information kit or mail it to the address listed on the last page of the form. We include two enrollment forms with each kit, so if a spouse also wants to enroll, you can use the same kit.

Enroll in Person

enroll in person icon We are happy to send a plan representative to your home or other location of your choice to answer any questions you may have. Understand that you are not obligated in any way to enroll when meeting with one of our representatives. Please call us toll free at 1-866-509-5398 (TTY 711) to make an appointment.

Telephone lines are open 8 am to 8 pm, 7 days a week. You may receive a messaging service on weekends and holidays from February 15 through September 30. Please leave a message and your call will be returned the next business day.

Click here to view our plan’s Medicare ratings.

Click Here to learn more about getting extra help to pay for your prescription drug premiums and costs.

Our Service Area

Essence Advantage (HMO) is available to Medicare eligible residents within the Missouri counties of Boone, Jefferson, Saint Charles, Saint Louis, St. Louis City and Saint Francois and the Illinois counties of Madison, Monroe and St. Clair.

Essence Advantage Plus (HMO) is available to Medicare eligible residents within the Missouri counties of Jefferson, Saint Charles, Saint Louis, St. Louis City and Saint Francois and the Illinois counties of Madison, Monroe and St. Clair.

Essence Platinum (HMO-POS) is available to Medicare eligible residents within the Missouri counties of Jefferson, Saint Charles, Saint Louis and St. Louis City.

CoxHealth MedicarePlus (HMO) is available to Medicare eligible residents within the Missouri counties of Christian, Greene, Stone and Taney.

Our Annual Government Contract

Essence Healthcare’s contract is renewed annually and the availability of coverage beyond the end of 2016 is anticipated but not guaranteed. By law, plan sponsors may choose to not renew their government contract, and the government may also refuse to renew the contract. If this happened, beneficiaries would need to join another plan offered in their area. Each year, we are also allowed to reduce our service area and/or no longer offer services in the areas where a beneficiary resides. Such a change is not anticipated. If it happened, beneficiaries would need to join another plan offered in their area.

Essence is an HMO plan with a Medicare contract. Enrollment in Essence depends on contract renewal. Members must have Medicare Parts A and B, and reside in our service area, to participate in our plan. Enrollment is limited to certain times of the year. You must continue to pay your Medicare Part B premium. Members must use plan providers for routine care and receive their prescription drug benefits from Essence. An additional cost may be assessed for using out-of-network providers. Please consult the Summary of Benefits and the Evidence of Coverage for other important enrollment and membership information. Medicare beneficiaries may also enroll in Essence through the CMS Medicare Online Enrollment Center located at www.medicare.gov.

Rights and Responsibilities when Leaving or Changing Plans

“Disenrollment” from Essence means ending your membership in our plan. Disenrollment can be voluntary or involuntary:

You might leave Essence because you have decided that you want to leave. You can do this for any reason; however, there are limits to when you may leave, how often you can make changes, what your other choices are for receiving Medicare services and how you can make changes.

There are also a few situations where you would be required to leave our plan. For example, you would have to leave Essence if you permanently move out of our geographic service area or if Essence leaves the Medicare program. We will not ask you to leave our plan because of your health.

Until your membership ends, you must keep getting your Medicare services through Essence, or you will have to pay for them yourself.

If you leave our plan, it may take some time for your membership to end and your new way of getting Medicare to take effect. While you are waiting for your membership to end, you are still a member and must continue to get your care as usual through our health plan.

If you get services from doctors or other medical providers who are not plan providers before your membership in our plan ends, neither Essence nor the Medicare program will pay for these services, with just a few exceptions. The exceptions are: urgently needed care, care for a medical emergency, out-of-area renal dialysis services, and care that has been approved by us. Another possible exception is if you happen to be hospitalized on the day your membership ends. If this happens to you, call us to find out if your hospital care will be covered. If you have any questions about leaving Essence, please call us.

If you want to leave our health plan:

The first step is to be sure that the type of change you want to make (and when you want to make it) fits within the rules about changing how you get Medicare. If the change does not fit with these rules, you won’t be allowed to make the change.

Then, what you must do to leave Essence depends on whether you want to switch to Original Medicare or to one of your other choices.

In general, there are only certain times during the year when you can change the way you get Medicare. Each year, anyone can disenroll and join a different plan during the Medicare Annual Enrollment Period that starts October 15th and ends December 7th. Anyone can also disenroll from a Medicare Advantage plan, such as Essence, and return to Original Medicare during the Medicare Advantage Disenrollment Period which begins January 1st and ends February 14th. You may be able to switch plans outside these periods under certain special circumstances called “Special Elections.” Your Essence plan’s Evidence of Coverage outlines these rules or you can contact us for information.