A non-government entity
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 Clark and Nye Counties. 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. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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 $900.00 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:
Sign up for Select Health Medicare Essential (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Select Health Medicare Essential (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, standard generic drugs have a $47.00 copay, while non-preferred drugs have 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers comprehensive coverage with a variety of benefits. This plan covers inpatient and outpatient services, including emergency care, with varying copays for specific services like ambulance and mental health. Routine hearing and vision exams are included, along with dental services up to $2,500 annually. Additional benefits include home health services with no copay, as well as coverage for medical equipment, diagnostic services, and skilled nursing facilities. This plan also offers preventive services, such as annual physical exams, and other services like home infusion, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, though Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute are covered with no limit.
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. Individual outpatient substance abuse sessions have a copay of $15, and group sessions have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Essential (HMO) plan with a $55 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Select Health Medicare Essential (HMO) plan. Ground and Air Ambulance Services have a $200 copay, and Transportation Services to a Plan Approved Health-related Location are covered for 60 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Select Health Medicare Essential (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $10 copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
The Select Health Medicare Essential (HMO) plan covers Primary Care Physician 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. Chiropractic Services are covered, but Routine Chiropractic Care is not covered. Individual and Group Sessions for Mental Health Specialty Services have a copay of $15 and $10, respectively. Individual and Group Sessions for Psychiatric Services have a copay of $15 and $10, respectively. Opioid Treatment Program Services have a copay of $10. Routine Foot Care is covered for up to 6 visits per year. Physical Therapy and Speech-Language Pathology Services, and Occupational Therapy Services have no copay or coinsurance.
Preventive Services See details
The Select Health Medicare Essential (HMO) plan covers preventive services including Medicare-covered preventive services, annual physical exams, health education, medical nutrition therapy, nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. This plan does not cover in-home safety assessments, 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, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, or counseling services.
Hearing Services See details
Hearing exams, including routine hearing exams, and fitting/evaluation for hearing aids are covered. Prescription hearing aids are covered with a copay between $99 and $699, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Select Health Medicare Essential (HMO) plan covers vision services, including routine eye exams and other eye exam services, with one visit allowed every year. Eyewear is covered, with a combined maximum plan benefit of $300 every year for contact lenses, eyeglasses (lenses and frames), and upgrades, but eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $2,500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered, but are limited to one visit every six months. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare Essential (HMO) plan, requiring a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Select Health Medicare Essential (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, and Medical Supplies with 20% coinsurance, while Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for diagnostic procedures and tests with no copay, but with coinsurance up to 20%, while lab services are not covered. Diagnostic Radiological Services have a copay of up to $60, and Therapeutic Radiological Services have coinsurance of up to 20%; however, Outpatient X-Ray Services are not covered.
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 requires authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Select Health Medicare Essential (HMO) plan. There is no copay for days 1-20, and a $125 copay for days 21-100.
Other Services See details
The Select Health Medicare Essential (HMO) plan's "Other Services" benefit covers over-the-counter items and a meal benefit for chronic illnesses, but acupuncture, Dual Eligible SNPs, and many other services are not covered. The meal benefit requires prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved