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Select Health Medicare Enhanced (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare Enhanced (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 Enhanced (HMO) in 2025, please refer to our full plan details page.
Select Health Medicare Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $63.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4700.00 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 Enhanced (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $6 copay for preferred generic drugs at a standard pharmacy, or a $0 copay for preferred generic drugs through mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, you may have a reduced monthly premium. This plan offers an enhanced alternative drug benefit type.
Additional Benefits
The Select Health Medicare Enhanced (HMO) plan offers a wide range of benefits beyond standard Medicare coverage. This plan includes coverage for inpatient and outpatient services, with varying copays and coinsurance depending on the specific service. You can expect to have a copay for services like emergency care, primary care visits, hearing and vision exams, and dental services. Additional benefits include coverage for hearing aids, eyewear, and dental services, with specific limits and cost-sharing arrangements. The plan also covers home health services, skilled nursing facility stays, and various therapies with specific copays or coinsurance. You will also have access to other benefits such as ambulance and transportation services, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-4, and no copay for days 5-90. For Inpatient Hospital Psychiatric, you will pay a $350 copay 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 are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient Hospital Services have a 20% coinsurance and a copay between $15 and $300, while Observation Services have a $300 copay. Ambulatory Surgical Center (ASC) Services have a $200 copay, and Outpatient Substance Abuse Services have a copay of $20 for individual sessions and $15 for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Enhanced (HMO) plan, and requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with both ground and air ambulance services requiring a $250 copay. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered with a copay of $125 and $35 respectively, and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered with copays of $125, $35, and $250 respectively, and no coinsurance.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $20 copay, Occupational Therapy services have a $20 copay, Physician Specialist Services have a $15 copay, Individual Sessions for Mental Health and Psychiatric Services have a $20 copay, Group Sessions for Mental Health and Psychiatric Services have a $15 copay, Podiatry Services and Routine Foot Care have a $15 copay, Physical Therapy and Speech-Language Pathology Services have a $20 copay, and Additional Telehealth Benefits have a $0-$15 copay, and Opioid Treatment Program Services have a 10% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
The Select Health Medicare Enhanced (HMO) plan covers preventive services, including Medicare-covered services with no copay. Additional covered services include annual physical exams, health education, in-home safety assessments, medical nutrition therapy, weight management programs, nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, home and bathroom safety devices, kidney disease education services, glaucoma screening, 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, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers, 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, and prescription hearing aids. The plan covers Routine Hearing Exams and Fitting/Evaluation for Hearing Aid each once per year. Prescription Hearing Aids (all types) are covered with a copay between $299 and $1799, while Inner Ear, Outer Ear, and Over the Ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $15 copay, and eyewear. Eyewear includes a $200 combined maximum amount per year for contact lenses, eyeglasses (lenses and frames), and upgrades.
Dental Services See details
The Select Health Medicare Enhanced (HMO) plan covers Medicare Dental Services with a $15 copay, and other dental services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventative dental services are covered, but fluoride treatment, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare Enhanced (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a maximum copay of $15 and a coinsurance of at most 20%, Diagnostic Radiological Services with a maximum copay of $150, and Therapeutic Radiological Services with a coinsurance of at most 20%. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by Select Health Medicare Enhanced (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, and the plan covers days 1-20 and days 51-100 with no copay, while days 21-50 have a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and meal benefits, though acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. The plan covers OTC items, and the meal benefit requires prior authorization.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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