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Select Health Medicare Essential (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare Essential (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Select Health Medicare Essential (HMO) in 2025, please refer to our full plan details page.
Select Health Medicare Essential (HMO) is a HMO plan offered by Intermountain Health Care, Inc. available for enrollment in 2025 to people living in Northern Utah. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Select Health Medicare Essential (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Select Health Medicare Essential (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Select Health Medicare Essential (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Select Health Medicare Essential (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, you may pay a $10 copay for a preferred generic drug at a standard pharmacy or 17% coinsurance for a standard generic drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers a range of services with varying costs. You'll pay a copay for inpatient hospital stays, outpatient services, and emergency care, with some services like home health and skilled nursing facilities having no copay for specific periods. The plan also covers primary care, hearing, vision, and dental services, with copays for exams and procedures, and some coinsurance for medical equipment and other services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, you will pay a $410 copay for days 1-5, and no copay for days 6-90; for psychiatric care, you will pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a 20% coinsurance and a copay between $15-$350, observation services with a $350 copay, ambulatory surgical center services with a $200 copay, outpatient substance abuse services with a $20-$25 copay, and outpatient blood services. Outpatient blood services have an enhanced benefit with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Essential (HMO) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
The Select Health Medicare Essential (HMO) plan covers ambulance services, including ground and air ambulance services, each with a $280 copay and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $40 copay, and Worldwide Emergency Transportation has a $280 copay. There is no coinsurance for any of these services.
Primary Care See details
The Select Health Medicare Essential (HMO) plan covers primary care physician services, chiropractic services with a $20 copay (routine care is not covered), occupational therapy services with a $20 copay, physician specialist services with a $15 copay, mental health specialty services with a $15 copay for individual and group sessions, podiatry services (including routine foot care) with a $15 copay, other health care professional services with a copay between $0 and $15, psychiatric services with a $15 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $15, and opioid treatment program services with 10% coinsurance.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Additional services like health education, in-home safety assessments, medical nutrition therapy, fitness benefits, remote access technologies, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered. Personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, as well as coverage for routine hearing exams and fitting/evaluation for hearing aids once per year. Prescription hearing aids (all types) are covered with a copay between $299 and $1799.
Vision Services See details
Vision Services include coverage for eye exams with a $15 copay. Eyewear is covered, with a combined maximum of $200 per year for contact lenses, eyeglasses (lenses and frames), and upgrades. Eyeglass lenses and frames are not covered.
Dental Services See details
The Select Health Medicare Essential (HMO) plan covers dental services, including oral exams with a $15 copay, Dental X-Rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services, each with a limit of one visit every six months. This plan has a $1500 maximum benefit for other dental services, and orthodontic services are covered under diagnostic and preventive dental. Fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Select Health Medicare Essential (HMO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Select Health Medicare Essential (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20% and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance, with no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay of up to $15 and coinsurance up to 20%, and Diagnostic Radiological Services with a copay of up to $250.00. Lab Services and Outpatient X-Ray Services are not covered, and Therapeutic Radiological Services have coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Select Health Medicare Essential (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for Cardiac Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-55, and no copay for days 56-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Select Health Medicare Essential (HMO) plan covers Over-the-Counter (OTC) Items and Meal Benefits. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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