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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 2026, 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 3.5 out of 5 stars in 2026.
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 $5500.00 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 features a $200 drug deductible and offers excellent savings on generic medications. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at standard retail pharmacies or through standard mail order. For Tier 2 generic drugs, standard mail order copays are as low as $5 for a one-month supply, while standard retail pharmacy copays start at $10. For brand-name and specialty medications, your costs are determined by coinsurance percentages during the initial coverage phase. Tier 3 preferred brand drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 30% coinsurance for standard options.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers comprehensive coverage with no copays or coinsurance for primary care doctor visits, preventive services, and home health care. Specialist office visits require a $30 copay with no coinsurance, while emergency room visits carry a $130 copay. For inpatient hospital stays, members pay a daily copay of $495 for the first five days of acute stays, with no copay required for subsequent days. This plan also features valuable dental, vision, and hearing benefits to help reduce your out-of-pocket costs. Preventive dental services and routine eyewear are covered with no copays, while routine eye and hearing exams require a $30 copay. Additionally, members receive an allowance of up to $50 every three months for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Select Health Medicare Essential (HMO) with no coinsurance, requiring prior authorization and a daily copay of $495 for days 1 to 5 of acute stays (no copay for days 6 and beyond) and $450 for days 1 to 5 of psychiatric stays (no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Select Health Medicare Essential (HMO) covers outpatient hospital services with a $30 to $425 copay and 20% coinsurance, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse services require no coinsurance and a copay of $20 for group or $25 for individual sessions, while outpatient blood services are available with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Select Health Medicare Essential (HMO) with a $140 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under Select Health Medicare Essential (HMO) cover ground and air ambulance services with a $375 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Select Health Medicare Essential (HMO) covers emergency services with a $130 copay and urgently needed services with a $40 copay, both featuring no coinsurance and copay waivers if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance, requiring copays of $130 for emergency care, $40 for urgent care, and $375 for emergency transportation.
Primary Care See details
Select Health Medicare Essential (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, speech, and mental health therapy services require a $20 copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Select Health Medicare Essential (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered, featuring fitness programs and remote access technologies, though services like health education, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Select Health Medicare Essential (HMO) covers routine hearing exams and fitting evaluations once per year with a $30 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $299.00 to $1,975.00 and no coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Select Health Medicare Essential (HMO) partially covers vision services with no deductibles, offering routine eye exams for a $30 copay and no coinsurance, and eyewear with no copay or coinsurance up to a $200 annual limit. Under this plan, contact lenses and upgrades are covered, but individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Select Health Medicare Essential (HMO), offering Medicare-covered dental for a $30 copay and no coinsurance, alongside preventive services with no copay and no coinsurance up to a $1,000 yearly limit. Comprehensive services like periodontics and oral surgery require no copay and 20% coinsurance, but fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Select Health Medicare Essential (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Select Health Medicare Essential (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Select Health Medicare Essential (HMO) covers medical equipment with no copay, though prior authorization is required and diabetic supplies are not covered. Durable medical equipment carries 0% to 20% coinsurance, while covered prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under Select Health Medicare Essential (HMO), with prior authorization required and no coverage for Lab Services and Outpatient X-Ray Services. Covered diagnostic procedures and tests require no coinsurance and a $0 to $30 copay, while diagnostic radiological services have no copay, and therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home health services are covered by Select Health Medicare Essential (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Select Health Medicare Essential (HMO) covers some cardiac rehabilitation services with no copay, no coinsurance, and prior authorization required, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Select Health Medicare Essential (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 56 to 100, while days 21 to 55 require a $218 daily copay, with additional days beyond the standard Medicare limit not covered.
Other Services See details
Select Health Medicare Essential (HMO) covers select other services with no copay and no coinsurance, including meals for chronic illness with prior authorization and up to $50 every three months for over-the-counter items. Acupuncture, nicotine replacement therapy, and other additional services are not covered.
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