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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 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 Iron, Sanpete, Sevier, Wayne, Washington. 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 $5.00. 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 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 $5700.00 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 has a $200 deductible for prescription drugs. After the deductible, you will pay varying costs depending on the drug tier and pharmacy. In the initial coverage phase, you may pay a copay or coinsurance for your prescriptions. For example, in the standard pharmacy, you will pay a $15 copay for preferred generic drugs, and 14% coinsurance for standard generic drugs. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for your covered drugs.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays or coinsurance depending on the service. Emergency and primary care services typically have copays, with some services requiring prior authorization. The plan includes coverage for hearing, vision, and dental services with copays, along with home health and skilled nursing facility services. The plan also covers medical equipment, and diagnostic and radiological services with copays or coinsurance. Additionally, the plan covers some over-the-counter items and offers a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you will pay a $475 copay for days 1-4, and no copay for days 5-90; for psychiatric care, you will pay a $465 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a coinsurance of 20% and a copay between $20 and $350, while observation services have a $350 copay. Ambulatory surgical center services have a $250 copay, and outpatient substance abuse services have a $20 copay for individual sessions and a $15 copay for group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Essential (HMO) plan. This benefit requires prior authorization and has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $250 copay, and there is no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Select Health Medicare Essential (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $35 copay, both with no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $250 copay, all with no coinsurance.
Primary Care See details
The Select Health Medicare Essential (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services require prior authorization and have a $20 copay for routine care. Occupational therapy services have a $20 copay and no coinsurance. Physician specialist services have a $20 copay. Mental health specialty services have a $20 copay for individual sessions and a $15 copay for group sessions. Podiatry services, including routine foot care, have a $20 copay. Other health care professional services have a copay ranging from $0-$20. Psychiatric services have a $20 copay for individual sessions and a $15 copay for group sessions. Physical therapy and speech-language pathology services have a $20 copay and no coinsurance. Additional telehealth benefits have a $0-$20 copay. Opioid treatment program services require prior authorization and have a 10% coinsurance.
Preventive Services See details
The Select Health Medicare Essential (HMO) plan covers a variety of preventive services, including 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, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, this plan does not cover Personal Emergency Response Systems (PERS), 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, or counseling services.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription hearing aids (all types) have a copay between $699 and $999, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Select Health Medicare Essential (HMO) plan covers routine eye exams with a $20 copay, and other eye exam services once per year. Eyewear is covered, with a combined maximum of $200 per year for contact lenses, eyeglasses (lenses and frames), and upgrades. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, prosthodontics (fixed), and oral and maxillofacial surgery; however, fluoride treatment, implant services, and orthodontics are not covered. The plan offers a maximum of $2,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, the copay is $35, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare Essential (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a maximum copay of $20 and no coinsurance, and Diagnostic Radiological Services with a maximum copay of $150 and no coinsurance. Therapeutic Radiological Services have a maximum coinsurance of 20% and no copay. Lab services and 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 prior authorization is required. 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 Essential (HMO) plan, including services for Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD), additional cardiac rehabilitation, intensive cardiac rehabilitation, and pulmonary rehabilitation. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. There is no copay for days 1-20 and 56-100, but there is a $214 copay for days 21-55. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Select Health Medicare Essential (HMO) plan covers Over-the-Counter (OTC) items, and a meal benefit for chronic illnesses, but acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered. The plan does not have a maximum benefit coverage amount for OTC items, and the plan offers Naloxone coverage as a Part C OTC benefit.
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