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Select Health Medicare NoRx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare NoRx (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 NoRx (HMO) in 2026, please refer to our full plan details page.
Select Health Medicare NoRx (HMO) is a HMO plan offered by Intermountain Health Care, Inc. available for enrollment in 2025 to people living in Davis, Salt Lake, Utah, and Weber Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Select Health Medicare NoRx (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Select Health Medicare NoRx (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 NoRx (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 $100.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Select Health Medicare NoRx (HMO).
Additional Benefits
The Select Health Medicare NoRx (HMO) plan offers robust medical coverage featuring no copays and no coinsurance for primary care visits, preventive care, and home health services. Specialist visits require a $50 copay, while inpatient hospital stays incur a $500 daily copay for the first five days. Outpatient hospital services range from a $50 to $400 copay with 20% coinsurance, and emergency room visits require a $130 copay that is waived upon admission. For specialized care, the plan provides preventive dental services with no copay or coinsurance up to a $1,500 annual limit, while routine vision and hearing exams require a $50 copay. Skilled nursing facility stays feature no copay for days 1 to 20 and days 56 to 100, alongside no copays or coinsurance for over-the-counter items. Diagnostic radiology services and cardiac rehabilitation are also covered with no copays or coinsurance, helping keep your out-of-pocket costs predictable.
Inpatient Hospital See details
Select Health Medicare NoRx (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $500 daily copay for days 1-5 and no copay for days 6-90, while psychiatric stays require a $400 daily copay for days 1-5 and no copay thereafter. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Select Health Medicare NoRx (HMO), featuring outpatient hospital services with a $50 to $400 copay and 20% coinsurance, and ambulatory surgical center visits for a $250 copay and no coinsurance. Outpatient substance abuse sessions require a $15 to $25 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Select Health Medicare NoRx (HMO) with a $140.00 copay and no coinsurance, though prior authorization is required for some of these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Select Health Medicare NoRx (HMO), which features a $250 copay and no coinsurance for both ground and air ambulance services. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Select Health Medicare NoRx (HMO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance, requiring a $130 copay for emergency care, a $50 copay for urgent care, and a $250 copay for emergency transportation.
Primary Care See details
Select Health Medicare NoRx (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $50 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, while chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic care. Mental health and psychiatric individual sessions have a $25 copay and no coinsurance, while group sessions have a $15 copay and no coinsurance.
Preventive Services See details
Select Health Medicare NoRx (HMO) provides partial coverage for preventive services with no copay and no coinsurance for covered benefits, which include annual physicals, fitness benefits, and nutrition therapy. Some services are not covered, such as personal emergency response systems, alternative therapies, therapeutic massage, and in-home support services.
Hearing Services See details
Select Health Medicare NoRx (HMO) covers annual routine hearing exams and fitting evaluations with a $50 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $299 to $1,975, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Select Health Medicare NoRx (HMO), offering routine eye exams for a $50 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $200 annual maximum. While contact lenses and complete eyeglasses are covered, individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Select Health Medicare NoRx (HMO), which offers up to $1,500 annually with no copay and no coinsurance for preventive care, and a $50 copay with no coinsurance for Medicare-covered dental. Most comprehensive services require no copay and a 20% coinsurance, while fluoride treatments, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Select Health Medicare NoRx (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Select Health Medicare NoRx (HMO) with no copay and 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Select Health Medicare NoRx (HMO) plan with no copays and prior authorization required, featuring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with a 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Select Health Medicare NoRx (HMO) partially covers diagnostic and radiological services, requiring prior authorization and excluding lab services and outpatient x-rays. Covered diagnostic procedures and tests have no coinsurance and a copay of $0 to $50, diagnostic radiological services have no copay or coinsurance, and therapeutic radiological services require a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Select Health Medicare NoRx (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Select Health Medicare NoRx (HMO) covers cardiac rehabilitation services with no copay and no coinsurance, subject to prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Select Health Medicare NoRx (HMO) with no coinsurance, though prior authorization is required and additional days beyond the standard 100-day limit are not covered. You will pay no copay for days 1 to 20 and days 56 to 100, and a $218 daily copay for days 21 to 55, with no prior three-day hospital stay required.
Other Services See details
Other Services are partially covered by Select Health Medicare NoRx (HMO), providing over-the-counter (OTC) items and meal benefits for chronic illnesses with no copay and no coinsurance. Acupuncture is not covered, 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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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.
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