Medicare Advantage Plan H5211-002-0 in Bayfield County, WI Essence Rx (HMO-POS) • 2026
Plan H5211-002-0, marketed as Essence Rx (HMO-POS), is a Medicare Advantage Plan offered by Security Health Plan of Wisconsin, Inc., with prescription drug coverage. This 2026 Part C plan has a Health Maintenance Organization with a Point of Service (HMO-POS) provider network.
The latest CMS enrollment data shows an estimated 18,905 Medicare beneficiaries are enrolled in this plan, with 197 members in Bayfield County, WI.
Essence Rx Overview
Plan Overview for H5211-002-0 |
|
|---|---|
| CMS Plan ID: |
H5211-002-0
|
| Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: |
$87.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $3800.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $330.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Bayfield County, WI |
| Enrollment (Nationwide): | 18,905 beneficiaries |
| Enrollment (CMS – Local) | 197 beneficiaries in Bayfield County |
| Provided By: | Security Health Plan of Wisconsin, Inc. |
To learn more about your plan options, costs, and enrollment periods without agent assistance, try our helpful Medicare Resources below (click to open).
Frequently Asked Questions About Essence Rx (HMO-POS)
Here are some of the most frequently asked questions people have about Plan ID H5211-002-0:
What is the monthly premium for Essence Rx (HMO-POS)?
Essence Rx has a $87.00 monthly premium for 2026. You must also continue to pay any Medicare Part B premium you owe.
What is the out-of-pocket maximum for Plan ID H5211-002-0?
The 2026 in-network maximum out-of-pocket (MOOP) limit is $3800.00. After you reach this limit, the plan pays covered in-network Part A and Part B costs for the remainder of the year.
Is prescription drug coverage included with Essence Rx?
Yes. Essence Rx includes Medicare Part D prescription drug coverage. The 2026 Part D deductible is $330.00.
How many CMS stars does Essence Rx have?
For 2026, Essence Rx is included under CMS contract H5211, which has a ★4.5 out of 5 Star Rating.
Is Essence Rx an HMO, PPO, or another type of Medicare Advantage plan?
Essence Rx uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network.
How many people are enrolled in Essence Rx?
The most recent CMS enrollment data shows approximately 18,905 beneficiaries enrolled in Plan ID H5211-002-0.
Which insurance company offers Plan ID H5211-002-0?
Essence Rx is offered by Security Health Plan of Wisconsin, Inc..
Covered Services & Costs
Office Visits
This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Specialist: | In-network: $50 copay | Out-of-network: $50 copay |
Preventive and Wellness Services
Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$225 copay |
| Routine chiropractic: | In-network: $20 copay | Out-of-network: $20 copay |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
Diagnostic, Lab, and Imaging Services
Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $200 copay | Out-of-network: $200 copay |
| Lab services: | In-network: $5 copay | Out-of-network: $5 copay |
| Outpatient x-rays: | In-network: $5 copay | Out-of-network: $5 copay |
| Diagnostic tests and procedures: | In-network: $5 copay | Out-of-network: $5 copay |
Emergency and Urgent Care Services
Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $150 copay |
| Worldwide emergency care: | $150 copay |
| Urgent care: | $0-$50 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $300 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay | Out-of-network: | $300 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-6 | $20 per day for days 7-45 | $0 per day for days 46-100 | Out-of-network: | $0 per day for days 1-6 | $20 per day for days 7-45 | $0 per day for days 46-100 | $0 per stay |
| Ground ambulance: | In-network: $225 copay |
Mental Health Services
Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $40 copay | Out-of-network: $40 copay |
| Outpatient group therapy: | In-network: $40 copay | Out-of-network: $40 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $300 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay | Out-of-network: | $300 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
Rehabilitation Services
Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $30 copay | Out-of-network: $30 copay |
| Occupational therapy: | In-network: $30 copay | Out-of-network: $30 copay |
Medical Equipment and Supplies
Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 0%-20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
Medicare Part B Drugs
Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
Dental Services
Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
Vision Services
Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0-$50 copay | Out-of-network: $0-$50 copay |
| Contact lenses: | Not covered |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
Hearing Services
Hearing coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $50 copay | Out-of-network: $50 copay |
| Fitting/evaluation: | In-network: $50 copay | Out-of-network: $50 copay |
| Prescription hearing aids: | In-network: $500 copay |
| OTC hearing aids: | Not covered |
Additional and Special Needs Services
Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: 20% coinsurance |
Essence Rx covers 100% of certain preventive services as a required Part B benefit.
Prescription Drug Coverage
Part D Coverage Level (Benefit Design)
Essence Rx includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $29.10 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $29.10 |
| Low Income Premium Subsidy: | $21.12 |
| Low Income Premium Subsidy CMS Pays: | $21.10 |
| Low Income Subsidy Premium: | $8.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Plan Deductible
The Medicare Part D annual deductible with this plan is $330.00. This is the amount you must pay at the pharmacy before Security Health Plan of Wisconsin, Inc. begins paying its share.
Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Essence Rx has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $9.00 copay | Coming soon |
| Preferred Brand | $47.00 copay | Coming soon |
| Non-Preferred Drug | 40% coinsurance | Coming soon |
| Specialty Tier | 29% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS Medicare Star Ratings
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage HMO-POSs across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Security Health Plan of Wisconsin, Inc. plan.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Security Health Plan of Wisconsin, Inc.
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online .
| Contact Type | Details |
|---|---|
| Website: | Security Health Plan of Wisconsin, Inc. Plan Page |
| New Members: | 1-877-998-0998 |
| Existing Members: | 1-877-998-0998 |
| Plan Address: | 1515 North Saint Joseph Avenue | PO Box 8000 | Marshfield, WI 54449 |
Medicare Plan Decision Resources
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | 202608 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-08 |
| Publisher | Reference | Last Accessed |
|---|---|---|
| Security Health Plan of Wisconsin, Inc. (official source) | http://www.securityhealth.org/medicareadvantage | October 13, 2025 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
Medicare.org independently compiles and interprets Medicare plan information using data published by the Centers for Medicare & Medicaid Services (CMS), official plan information, and other authoritative Medicare sources. The sources used for this plan are documented below.
Medicare.org is an independent Medicare information and enrollment resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program. Enrollment assistance is provided through HealthCompare, an Allstate company.
Medicare plan data and editorial content curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for Medicare plan interpretation and publication.