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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 Iron, Piute, Sanpete, Sevier, Wayne, Washington. 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.
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 a $300.00 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 features a $300 drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay for up to a three-month supply at standard pharmacies and standard mail order. Tier 2 generic drugs require a $5.00 copay for a one-month supply at standard pharmacies, which drops to $4.00 when using standard mail order. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require 25% coinsurance, while Tier 4 non-preferred drugs require 30% coinsurance for standard retail and mail-order fills. Tier 5 specialty drugs are covered at 29% coinsurance for a one-month supply.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits and urgent care, members pay a $35 copay with no coinsurance, while emergency room visits require a $130 copay. Inpatient hospital stays require a copay of $475 per day for the first four days of acute stays, with no copay for days 5 through 90. This plan also provides key supplemental benefits, including preventive dental care with no copay up to a $1,000 annual limit and a $200 eyewear allowance with no copay. Routine vision and hearing exams are available for a $35 copay, with prescription hearing aids covered at copays ranging from $699 to $999. Additionally, members receive a $45 over-the-counter quarterly allowance and a chronic illness meal benefit with no copays.
Inpatient Hospital See details
Select Health Medicare Essential (HMO) inpatient hospital services are partially covered with no coinsurance, requiring a $475 copay for days 1 to 4 of acute stays and a $465 copay for days 1 to 4 of psychiatric stays, with no copay for days 5 to 90. Unlimited additional acute days are covered, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Select Health Medicare Essential (HMO) covers outpatient hospital services with a copay of $35 to $350 and 20% coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse services require a $15 to $20 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Select Health Medicare Essential (HMO) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Select Health Medicare Essential (HMO), with ground and air ambulance services requiring a $250 copay and no coinsurance. For transportation, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Select Health Medicare Essential (HMO) covers emergency services with a $130 copay and urgently needed services with a $35 copay, both featuring no coinsurance and copay waivers if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and emergency transportation services are also covered with no coinsurance and copays of $130, $35, and $250 respectively.
Primary Care See details
Select Health Medicare Essential (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical, occupational, and speech therapy are covered with a $20 copay and no coinsurance, while chiropractic services are only partially covered since routine chiropractic care is not covered.
Preventive Services See details
Select Health Medicare Essential (HMO) provides preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. This benefit is partially covered, as excluded services include health education, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Select Health Medicare Essential (HMO), which offers annual routine exams and fitting evaluations for a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services under Select Health Medicare Essential (HMO) are partially covered, offering annual routine and refraction eye exams for a $35 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $200 annual maximum, but eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Select Health Medicare Essential (HMO) partially covers dental services, offering preventive care like exams and cleanings with no copay and no coinsurance up to a $1,000 annual limit, though fluoride is not covered. Medicare-covered dental services have a $35 copay and no coinsurance, while covered comprehensive services require no copay and 20% coinsurance, with implants and orthodontics excluded from coverage.
Home Infusion bundled Services See details
Select Health Medicare Essential (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Select Health Medicare Essential (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under the Select Health Medicare Essential (HMO) with no copays and prior authorization required, featuring 0% to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics, medical supplies, and diabetic shoes. Diabetic equipment is only partially covered, as diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Select Health Medicare Essential (HMO) partially covers diagnostic and radiological services with prior authorization required, though lab services and outpatient x-ray services are not covered. Covered diagnostic procedures and tests feature no coinsurance and a copay of up to $35, while diagnostic radiological services have no copay or coinsurance, and therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered by Select Health Medicare Essential (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Select Health Medicare Essential (HMO), requiring prior authorization with no coinsurance and a $10 copayment for eligible services. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Select Health Medicare Essential (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 56 to 100, a $218 daily copay applies for days 21 to 55, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Select Health Medicare Essential (HMO), featuring no copay and no coinsurance for both a chronic illness meal benefit and over-the-counter items up to $45 every three months. Acupuncture, nicotine replacement therapy, and dual-eligible SNP services are not covered under this benefit.
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