Essential vs. Plus: which to offer
$59 vs. $129 per employee. The difference is in-person access.
Your employees need coverage. You're deciding between Essential at $59 per employee per month and Plus at $129. The $70 difference comes down to one key factor: in-person care access.
Core coverage comparison
Both plans include the same foundation. Members get unlimited Virtual Primary Care through text, phone, or video with U.S.-based doctors licensed in their state. Both cover preventive care at 100% when using in-network providers. Mental health therapy sessions are included, and hundreds of generic medications cost $0 at pharmacies nationwide.
The plans differ in scope. Essential provides 6 mental health sessions per year and covers 500+ common generics. Plus expands to 10 sessions and 1,000+ generics on the formulary.
What both plans include
- 24/7 Virtual Primary Care. Text, phone, or video with licensed doctors.
- $0 preventive care. Annual physicals, screenings, and immunizations in-network.
- Mental health therapy. Scheduled sessions with licensed therapists.
- $0 generic prescriptions. Common medications at no cost through the formulary.
The Plus plan difference
Plus adds in-person medical visits beyond preventive care. Members receive 5 primary care visits, 1 specialist visit, and 2 urgent care visits annually. These visits have copays but give members options when virtual care isn't enough.
This matters for your workforce demographics. Employees managing chronic conditions benefit from regular in-person checkups. Workers with families appreciate urgent care access for their dependents. The broader generic formulary also helps those on maintenance medications.
Consider your turnover rate when evaluating the extra $70 monthly cost. High-turnover workforces may not fully utilize the additional visits. Stable teams with longer tenure extract more value from expanded benefits.
Your variable-hour employees face unique challenges accessing care. Essential covers their ACA requirement and provides solid virtual-first benefits. Plus recognizes that some health needs require hands-on evaluation. The right choice depends on your team's specific needs and your benefits budget.
Both MEC plans help you meet ACA obligations while controlling costs. The decision between Essential and Plus comes down to whether your workforce needs that bridge to in-person care.
Frequently Asked Questions
Can employees switch from Essential to Plus during the year?
Plan changes typically happen during your company's annual enrollment period or when an employee changes job classification. If your workforce is divided into different classes (like full-time versus part-time), employees who move between classes may become eligible for different plan options. Contact your account manager to understand your specific enrollment rules and timing.
What happens if a Plus member uses more than their 5 primary care visits?
After using the included visits, members pay the full negotiated rate for additional in-person primary care visits. They can still access unlimited Virtual Primary Care at no cost throughout the year. The visit limits reset annually, so unused visits don't roll over to the next plan year.
Do the copays for Plus plan visits vary by location?
Copay amounts are set when you receive your quote and remain consistent across your enrolled population. The specific dollar amounts depend on your plan design and are detailed in your employee materials. Geographic location doesn't change the copay, but provider network availability may vary by area.
Are dependents covered under these plans?
Both Essential and Plus can include dependent coverage for spouses and children. Dependent pricing is shared during the quoting process and varies based on your specific plan design. Dependents receive the same benefits as the primary member, including Virtual Primary Care access and the same annual visit allowances under Plus.