Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H6200-011

Medicare Plan

Essence Advantage Premier Plus (PPO) · Essence Healthcare · Local PPO · Chicago Metropolitan Area

Full CMS plan ID: H6200-011-000

H6200-011-000 is the full CMS identifier for the H6200-011 Medicare plan. Common searches include H6200 011 and H6200011.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Essence Advantage Premier Plus (PPO)

H6200-011-000 Chicago Metropolitan Area Local PPO

At-a-glance

Quick view

01

In-network

Inpatient hospital

Per admission $500 per stay
Plan-listed inpatient copay $500
02

Emergency transport

Ambulance

Ground · in-networkCost share not reported
Air · in-networkCost share not reported
03

Emergency services

Emergency room

Cost share not reported

04

Medical maximum

Maximum out-of-pocket

In-network$2,000
Combined in + out$2,000
05

Skilled care at home

Home health

In-networkCost share not reported
Out-of-networkCost share not reported
06

Monthly cost

Premium & giveback

Part C premium$206.70 / month
Consolidated C + D$257 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkCost share not reported
Out-of-networkCost share not reported

Specialist

In-networkCost share not reported
Out-of-networkCost share not reported

Preventive care

In-networkCost share not reported
Out-of-networkCost share not reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkCost share not reported
Out-of-networkCost share not reported

Laboratory services

In-networkCost share not reported
Out-of-networkCost share not reported

X-rays & standard imaging

In-networkCost share not reported
Out-of-networkCost share not reported

MRI, CT & PET imaging

In-networkCost share not reported
Out-of-networkCost share not reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-networkCost share not reported
Out-of-networkNot separately reported

Ground ambulance

In-networkCost share not reported
Out-of-networkCost share not reported

Air ambulance

In-networkCost share not reported
Out-of-networkCost share not reported

Outpatient hospital

In-networkCost share not reported
Out-of-networkCost share not reported

Outpatient surgery / ASC

In-networkCost share not reported
Out-of-networkCost share not reported
Recovery & therapy5 benefits

Home health

In-networkCost share not reported
Out-of-networkCost share not reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-networkCost share not reported
Out-of-networkCost share not reported

Occupational therapy

In-networkCost share not reported
Out-of-networkCost share not reported

Physical & speech therapy

In-networkCost share not reported
Out-of-networkCost share not reported
Behavioral health2 benefits

Mental health services

In-networkCost share not reported
Out-of-networkCost share not reported

Substance use treatment

In-networkCost share not reported
Out-of-networkCost share not reported
Specialty care2 benefits

Podiatry

In-networkCost share not reported
Out-of-networkCost share not reported

Chiropractic

In-networkCost share not reported
Out-of-networkCost share not reported
Supplemental benefits7 benefits

Dental

In-networkCost share not reported
Out-of-networkCost share not reported

Vision

In-networkCost share not reported
Out-of-networkCost share not reported

Hearing

In-networkCost share not reported
Out-of-networkCost share not reported

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

In-networkCost share not reported
Out-of-networkCost share not reported

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

Not reported in this CMS export

Not reported in this CMS export

Plan costs & rulesCoverage overview

Premium & Part B giveback

$206.70 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$2,000
Combined in + out$2,000

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs5 tiers

Part D deductible

Not reported

Drug tier 1

$15 retail copay · 30-day supply

Drug tier 2

$20 retail copay · 30-day supply

Drug tier 3

$47 retail copay · 30-day supply

Drug tier 4

50% retail coinsurance · 30-day supply

Drug tier 5

25% retail coinsurance · 30-day supply

Using this plan

Understand H6200-011-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Essence Advantage Premier Plus (PPO) is a 2026 Local PPO offered by Essence Healthcare in Chicago Metropolitan Area. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $500 across null charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Cost share not reported
Specialist
Cost share not reported
Laboratory services
Cost share not reported

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Cost share not reported
MRI, CT & PET imaging
Cost share not reported
Outpatient hospital
Cost share not reported

The service setting and billing details can change what you pay.

Emergency & hospital care

0
Listed inpatient stages
$500 total

null charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Chicago Metropolitan Area (IL)
Plan type
Local PPO
Contract / plan
H6200-011
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalCost share not reported
VisionCost share not reported
HearingCost share not reported
Fitness & wellnessCost share not reported

Plan-specific answers

Frequently asked questions

Where is H6200-011-000 available?

Essence Advantage Premier Plus (PPO) is listed for Chicago Metropolitan Area (IL). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H6200-011-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $2,000. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H6200-011-000?

The listed consolidated Part C and Part D premium is $257 per month. This does not replace the standard Medicare Part B premium.

Does H6200-011-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H6200-011-000 fits

Full CMS plan ID
H6200-011-000
Contract
H6200
Base plan code
H6200-011
Segment
000
Carrier
Essence Healthcare
Plan type
Local PPO
Service area
Chicago Metropolitan Area (IL)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Cook, IL
  • DuPage, IL
  • Will, IL

Same CMS contract

H6200-001-000 Essence Advantage Choice (PPO) St. Louis Metropolitan Area and Mid Missouri · Local PPO H6200-008-000 Essence Advantage Premier Plus (PPO) St. Louis Metropolitan Area · Local PPO H6200-009-000 Essence Advantage Choice (PPO) Chicago Metropolitan Area · Local PPO H6200-010-000 Essence Advantage Choice Plus (PPO) Chicago Metropolitan Area · Local PPO H6200-801-000 Essence Advantage EGWP PPO MAPD Calendar Yr (PPO) MO, IL, AR, KY and IN Service Areas · Local PPO H6200-802-000 Essence Advantage EGWP PPO MAPD non-Calendar Yr (PPO) MO, IL, AR, KY and IN Service Areas · Local PPO H6200-803-000 Essence Advantage EGWP PPO MA Only Calendar Yr (PPO) MO, IL, AR, KY and IN Service Areas · Local PPO H6200-804-000 Essence Advantage EGWP PPO MA Only non-Calendar Yr (PPO) MO, IL, AR, KY and IN Service Areas · Local PPO

About this code

What H6200-011-000 identifies

H6200-011-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H6200-011, H6200 011, or the compact full CMS ID H6200011000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.