A non-government entity
Select Health Medicare + Kroger (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare + Kroger (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 + Kroger (HMO) in 2025, please refer to our full plan details page.
Select Health Medicare + Kroger (HMO) is a HMO plan offered by Intermountain Health Care, Inc. available for enrollment in 2025 to people living in Clark and Nye. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Select Health Medicare + Kroger (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 + Kroger (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 + Kroger (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 $2.00. 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 $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 + Kroger (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, you will pay no copay at the preferred pharmacy or mail order, and a $15 copay at a standard pharmacy. For standard generic drugs, you will pay $40 at the preferred and mail order pharmacies, and $47 at the standard pharmacy.
Additional Benefits
The Select Health Medicare + Kroger (HMO) plan offers comprehensive coverage, including no copays for inpatient hospital stays, primary care, and home health services. This plan also includes benefits for outpatient services, emergency care, hearing, vision, and dental, as well as coverage for medical equipment and diagnostic services. While many services have no copay, it's important to note there are copays for services such as ambulance, emergency services, and outpatient substance abuse services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric care. Inpatient Hospital-Acute and Inpatient Hospital Psychiatric have no copay for Medicare-covered stays, and additional days for Inpatient Hospital-Acute are unlimited.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Individual and group sessions for outpatient substance abuse have a copay between $10 and $15, and outpatient blood services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare + Kroger (HMO) plan, but requires prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including Ground and Air Ambulance Services, each with a $250 copay and no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 60 one-way trips per year, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $140 copay and no coinsurance. Urgently Needed Services are covered, with a $10 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered with a $140, $10, and $250 copay respectively, and no coinsurance.
Primary Care See details
The Select Health Medicare + Kroger (HMO) plan's primary care benefit 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. Individual and group sessions for mental health and psychiatric services have a copay between $10 and $15, while all other services have no copay and no coinsurance.
Preventive Services See details
The Select Health Medicare + Kroger (HMO) plan covers preventive services, including annual physical exams and additional preventive services like health education, medical nutrition therapy, weight management programs, fitness benefits, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. However, 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, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids. Hearing exams and routine hearing exams are limited to one visit per year, and fitting/evaluation for hearing aids is limited to one visit per year. Prescription hearing aids are covered with a copay between $499 and $799, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Select Health Medicare + Kroger (HMO) plan covers routine eye exams and other eye exam services, with one exam covered per year, as well as contact lenses. This plan also covers eyeglasses (lenses and frames) with one pair covered every year, and upgrades, but does not cover eyeglass lenses or eyeglass frames. The plan offers a combined maximum of $200 per year for eyewear.
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 services, prophylaxis (cleaning), and fluoride treatments are covered, with a limit of one visit every six months. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare + Kroger (HMO) plan, requiring a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Select Health Medicare + Kroger (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, but does not cover DME for use outside the home. Medical supplies have a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a coinsurance of at most 20%, and diagnostic radiological services with a copay of at most $60.00. 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 + Kroger (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but this plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Select Health Medicare + Kroger (HMO) plan, with prior authorization and a doctor referral required. There is no copay for days 1-20 and days 41-100, but there is a $125 copay for days 21-40; however, additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, and Meal Benefits, but not Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Over-the-Counter (OTC) Items are covered, and Meal Benefits require prior authorization.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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