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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 Clark, Nye. 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. Additionally, this plan comes with a Part B Premium reduction of $1.90. 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 $1000.00 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 $0 prescription drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one-month, two-month, or three-month supplies filled through standard pharmacies or standard mail order. This makes managing your everyday generic prescriptions highly affordable. For brand-name and specialty medications, the plan transitions to standard copays and coinsurance. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while Tier 4 non-preferred drugs carry a $100 copay for a one-month supply, with multi-month options available for both. Specialty drugs in Tier 5 are subject to a 33% coinsurance for a one-month supply through standard pharmacies and mail order.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers robust coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, primary care, specialist visits, and outpatient surgeries. For urgent care and emergency services, members pay a low $10 copay and a $150 copay respectively, with no coinsurance required. Additionally, specialized services like home health care and routine podiatry are available with no copay or coinsurance, while skilled nursing facility stays require a daily copay only after the twentieth day. This plan also features strong supplemental benefits, including dental coverage up to a $2,500 annual limit with no copay for preventive services and vision care with no copay for routine annual exams. Members can access up to 60 free one-way health-related transportation trips per year and receive a $50 over-the-counter item allowance every three months. Prescription hearing aids are covered with copays ranging from $399 to $699, and durable medical equipment is available with a 20% coinsurance and no copay.
Inpatient Hospital See details
Select Health Medicare Essential (HMO) covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, though prior authorization and referrals are required. While unlimited additional days are covered for acute stays, upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Select Health Medicare Essential (HMO) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse services are also covered with no coinsurance, requiring a $15 copay for individual sessions and a $10 copay for group sessions.
Partial Hospitalization See details
Select Health Medicare Essential (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required for these services, and a referral may also be necessary.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Select Health Medicare Essential (HMO), featuring a $250 copay and no coinsurance for both ground and air ambulance services. The plan also provides up to 60 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any other health-related locations is not covered.
Emergency Services See details
Select Health Medicare Essential (HMO) covers emergency services with a $150 copay and urgently needed services with a $10 copay, with no coinsurance for either service and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and respective copays of $150, $10, and $250.
Primary Care See details
Select Health Medicare Essential (HMO) covers primary care, specialist, physical therapy, occupational therapy, and telehealth services with no copay and no coinsurance, while routine and other chiropractic services are not covered. Mental health and psychiatric services have no coinsurance with a $10 to $15 copay, opioid treatment has a $10 copay with no coinsurance, and routine podiatry is covered for up to 6 visits per year with no copay and no coinsurance.
Preventive Services See details
Select Health Medicare Essential (HMO) preventive services are partially covered with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, and fitness programs. However, several supplemental options are not covered, including health education, in-home safety assessments, personal emergency response systems, and weight management programs.
Hearing Services See details
Select Health Medicare Essential (HMO) hearing services are partially covered, offering one routine exam and one fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids have no coinsurance and a copay ranging from $399 to $699, but OTC hearing aids alongside inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Select Health Medicare Essential (HMO) covers vision services with no copay, no coinsurance, and no deductible, which includes one routine eye exam and one refraction exam per year. Eyewear is partially covered with a $200 annual maximum for contact lenses, upgrades, and one pair of eyeglasses, 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) up to a $2,500 annual maximum, offering no copay and no coinsurance for preventive care, endodontics, and periodontics, and no copay with 0% to 20% coinsurance for restorative and surgical services. Implant services and orthodontics are not covered under this plan.
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. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Select Health Medicare Essential (HMO) covers dialysis services with no copay and a 20% coinsurance, though a referral is required to receive care.
Medical Equipment See details
Select Health Medicare Essential (HMO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Select Health Medicare Essential (HMO) partially covers diagnostic and radiological services, requiring prior authorization and referrals for covered services. Diagnostic procedures and diagnostic radiological services are offered with no copay and no coinsurance, while therapeutic radiological services require a copay and 20% coinsurance; lab services and outpatient X-ray services are not covered.
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 and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Select Health Medicare Essential (HMO) plan, with cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services all being excluded from coverage.
Skilled Nursing Facility (SNF) See details
Select Health Medicare Essential (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $125 daily copay for days 21 to 100. Prior authorization and referrals are required, and any additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Other Services are partially covered under the Select Health Medicare Essential (HMO) plan, as acupuncture is not covered. Covered benefits include chronic illness meals requiring prior authorization and over-the-counter items up to $50 every three months, both offered with no copay and no coinsurance.
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