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Essence Healthcare Medicare Advantage Plans 2027: Plans, Markets and What's Changing

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) — Last updated October 10, 2026

Essence Healthcare is a St. Louis-based Medicare Advantage company that sells only Medicare plans. Its plans are powered by Lumeris, which provides the technology and care coordination behind its doctor networks, and Essence has built a reputation for high star ratings.

For 2027, Essence is growing slightly while many carriers shrink. CMS’s 2027 plan data lists 14 individual Essence plans, up from 13, across Missouri, Illinois, Kentucky and Arkansas. Annual Enrollment runs October 15 to December 7, 2026, for coverage that starts January 1, 2027.

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Essence Healthcare Medicare Advantage plans 2027 overview showing 14 plans, 7 HMO and 7 PPO, and the new Essence Advantage Prime plan

Essence Healthcare 2027 Plan Lineup

Essence sells 7 HMO plans and 7 PPO plans for 2027. The one new plan is Essence Advantage Prime (HMO) in select Central Missouri counties. Here’s the full lineup:

Market HMO Plans PPO Plans
St. Louis metro Essence Advantage, Essence Advantage Plus, Essence Advantage Select Essence Advantage Choice, Essence Advantage Premier Plus
Mid-Missouri Essence Advantage Select, Essence Advantage Prime (new) Essence Advantage Choice
Chicago metro Essence Advantage Select Essence Advantage Choice, Choice Plus, Premier Plus
Southwest Missouri and Northwest/Central Arkansas Essence Advantage Essence Advantage Choice
Louisville and Lexington, Kentucky Essence Advantage Essence Advantage Choice

Source: CMS 2027 Plan Benefit Package data, contracts H2610 (HMO) and H6200 (PPO), individual (non-employer) plans.

Essence doesn’t offer special needs plans in its individual lineup. If you have Medicaid or a qualifying chronic condition, see our guide to Medicare Advantage special needs plans.

What's Changing at Essence for 2027

Essence has published its own list of 2027 changes. The ones members are most likely to notice:

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Some PPO plans add a medical deductible, and PPO plans have pharmacy deductibles. HMO plans generally have no medical deductible.

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Out-of-pocket maximums are rising for some members.

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Flex Card changes: HMO allowances stay the same or increase, some PPO allowances go down, and the card can no longer be used for medical copays.

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The Oura Ring benefit is discontinued on many plans.

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Insulin moves tiers on HMO plans. The 2026 tier that held $0 insulins is removed, and insulins now fall under tiers 1 through 5. Part D out-of-pocket costs are capped at $2,400 in 2027.

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Network addition: Washington Regional joins the network in Northwest Arkansas.

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Rides through Uber on Essence Advantage and Advantage Plus HMO plans in St. Louis and Louisville/Lexington.

Current members should check their Annual Notice of Change for the exact changes to their plan. To see how Essence’s changes compare with the wider market, read our overview of Medicare Advantage plan changes for 2027.

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Chart of Essence Healthcare 2027 plans by market, including St. Louis, Chicago, Mid-Missouri, Arkansas and Kentucky

Essence Healthcare Markets and Star Ratings

St. Louis is Essence’s home market and its largest, with 5 plans. Chicago has 4, Mid-Missouri 3, and the Southwest Missouri/Arkansas and Louisville/Lexington markets 2 each.

Essence’s HMO contract was rated 4.5 stars for 2026, and Essence has earned 5 stars in past years. For 2026, Essence said it offered the only 4.5-star HMO in several of its markets, including St. Louis and Chicago. Medicare released 2027 ratings on October 8, 2026, so check the 2027 rating for your specific plan on Medicare.gov before you enroll. Compare carriers in our 2027 Medicare Advantage star ratings and our guide to 2027 Medicare Advantage plans by carrier.

Essence HMO vs PPO: Which Fits You?

An Essence HMO may fit if you:

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Are happy using Essence’s network and a primary care doctor

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Want to avoid a medical deductible

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Want an over-the-counter allowance. CMS’s 2027 data shows all 7 Essence HMO plans include one.

An Essence PPO may fit if you:

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Want the option to see out-of-network doctors, usually at a higher cost

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Don’t want to need referrals for specialists

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Are comfortable with a possible medical deductible in 2027

Learn more about Medicare Advantage PPO plans and Medicare Advantage HMO plans.

Before You Enroll: 2027 Checklist

1

Confirm your county. Essence plans are sold in select counties in each market.

2

Check your doctors and hospitals. Especially on HMO plans, which use the Essence network.

3

Run your prescriptions. Insulin users should check how their insulin is covered for 2027.

4

Check the deductible and out-of-pocket maximum. Both may change for 2027, especially on PPO plans.

5

Read your Annual Notice of Change. It lists every change to your current plan.

6

Mark the dates. Medicare Open Enrollment 2027 runs October 15 to December 7, 2026.

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Essence Healthcare Medicare Advantage 2027 — Frequently Asked Questions

➤ What is Essence Healthcare?

Essence Healthcare is a St. Louis-based company that sells Medicare Advantage plans in Missouri, Illinois, Kentucky and Arkansas. Its plans are powered by Lumeris, which supports its doctor networks with technology and care coordination.

➤ What Essence Healthcare plans are available in 2027?

CMS’s 2027 data lists 14 individual Essence plans: 7 HMOs (Essence Advantage, Advantage Plus, Advantage Select and the new Advantage Prime) and 7 PPOs (Essence Advantage Choice, Choice Plus and Premier Plus). Availability depends on your county.

➤ Where is Essence Healthcare available?

Essence sells plans in the St. Louis area, Mid-Missouri, Southwest Missouri, Northwest and Central Arkansas, the Chicago area, and the Louisville and Lexington areas of Kentucky. Each plan covers select counties.

➤ What is new at Essence Healthcare for 2027?

Essence adds a new plan, Essence Advantage Prime (HMO), in select Central Missouri counties. It also adds Washington Regional to its Northwest Arkansas network and launches the MyEssence mobile app.

➤ Does Essence Healthcare have a Flex Card in 2027?

Many Essence plans include a Flex Card. For 2027, Essence says HMO allowances stay the same or increase, some PPO allowances go down, and the card can no longer be used for medical copays. Check your plan’s Summary of Benefits for the amount.

➤ Is Essence Healthcare discontinuing the Oura Ring?

Yes, on many plans. Essence says it is discontinuing the Oura Ring benefit on many of its plans for 2027. Check your Annual Notice of Change to see if your plan is affected.

➤ What is the Essence Healthcare star rating?

Essence’s HMO contract was rated 4.5 stars for 2026, and Essence has earned 5 stars in past years. Medicare released 2027 ratings on October 8, 2026, so check your specific plan’s 2027 rating on Medicare.gov.

➤ Does Essence Healthcare have a deductible?

Essence HMO plans generally have no medical deductible, though some have a pharmacy deductible. For 2027, some Essence PPO plans add a medical deductible, and PPO plans have pharmacy deductibles.

➤ Does Essence Healthcare cover transportation?

Essence Advantage and Essence Advantage Plus HMO plans in the St. Louis and Louisville/Lexington markets include transportation through a partnership with Uber. Other plans may not include rides, so check your plan.

➤ When can I enroll in an Essence Healthcare plan for 2027?

Annual Enrollment runs October 15 to December 7, 2026, with coverage starting January 1, 2027. If you’re already in a Medicare Advantage plan, you can also make one change from January 1 to March 31, 2027.

New to Medicare?

If you are new to Medicare, then you can enroll in a 2027 Medicare Advantage plan up to three months prior to your Medicare Part B effective date.

Call one of our licensed insurance agents to see what the best time frame is for you to enroll, based on your current situation. You can contact them at 1-855-409-6195 (TTY 711), Mon–Fri 8am–9pm EST.

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