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Select Health Medicare Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare Classic (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 Classic (HMO) in 2025, please refer to our full plan details page.
Select Health Medicare Classic (HMO) is a HMO plan offered by Intermountain Health Care, Inc. available for enrollment in 2025 to people living in Southwest and Central Utah. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Select Health Medicare Classic (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 Classic (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 Classic (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $59.00. 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 $6700.00 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 Classic (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay a $10 copay for preferred generic drugs at a standard pharmacy. For standard generic drugs, you'll pay 14% coinsurance. For preferred brand drugs, you'll pay 19% coinsurance. For non-preferred drugs, you'll pay 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Select Health Medicare Classic (HMO) plan offers a variety of benefits, including inpatient hospital stays with copays ranging from $0 to $410 depending on the type of stay and length of time. The plan also covers outpatient services, such as hospital and substance abuse services, with varying copays and coinsurance. Additionally, this plan includes coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, and dental services, with specific cost-sharing amounts for each. This plan provides coverage for home infusion services, dialysis, medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility stays. The plan has no copay for home health services, but has copays and coinsurance for other services. However, the plan does not cover services such as cardiac rehabilitation, acupuncture, and private duty nursing, among other services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $410 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, the copay is $395 for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a 20% coinsurance and a copay between $25 and $350, while Observation Services have a $350 copay. Ambulatory Surgical Center Services have a $200 copay, and Individual and Group Sessions for Outpatient Substance Abuse have copays between $40 and $50. Outpatient Blood Services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Classic (HMO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
The Select Health Medicare Classic (HMO) plan covers ambulance services with a $275 copay for both ground and air ambulance services, but transportation services to any health-related location are not covered. There is no coinsurance for ambulance services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Select Health Medicare Classic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Transportation has a $275 copay; there is no coinsurance for any of these services.
Primary Care See details
The Select Health Medicare Classic (HMO) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy services (with a $20 copay), and physician specialist services (with a $25 copay). The plan also covers mental health specialty services with a $25 copay for individual and group sessions, podiatry services (with a $25 copay), other health care professional visits (with a copay between $0 and $25), and psychiatric services (with a $25 copay for individual and group sessions). Additionally, physical therapy and speech-language pathology services are covered with a $20 copay, additional telehealth benefits have a copay between $0 and $25, and opioid treatment program services are covered with 10% coinsurance.
Preventive Services See details
The Select Health Medicare Classic (HMO) plan covers a variety of preventive services, including Medicare-covered preventive services, annual physical exams, health education, in-home safety assessments, medical nutrition therapy, weight management programs, fitness benefits, remote access technologies, home and bathroom safety devices, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, 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, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are each covered once per year. Prescription Hearing Aids (all types) have a copay between $699 and $999, but prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay, contact lenses, and eyeglasses (lenses and frames). Eyewear has a combined maximum benefit of $200 every year, and eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered, with a $3,000 annual maximum. Medicare Dental Services have a $25 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services are covered, but limited to 1 visit every six months. 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 Classic (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay and between 0% and 20% coinsurance. Other covered drugs, including Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare Classic (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Select Health Medicare Classic (HMO) plan. Durable Medical Equipment has a coinsurance between 0% and 20% with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, and Medical Supplies have a 20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay of up to $25 and a coinsurance of up to 20%, while Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $320, and Therapeutic Radiological Services have a coinsurance of up to 20%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Select Health Medicare Classic (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Select Health Medicare Classic (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Select Health Medicare Classic (HMO) plan, but require prior authorization. There is no copay for days 1-20 and days 56-100, and a $214 copay for days 21-55. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Select Health Medicare Classic (HMO) plan does not cover 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, or Self-Directed Personal Assistance Services. Over-the-counter items and a meal benefit are covered, but the meal benefit requires prior authorization.
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