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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 2026, 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 3.5 out of 5 stars in 2026.
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.
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 $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 $1500.00 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 features a $200 drug deductible before coverage begins for certain tiers. For Tier 1 preferred generic drugs, you will pay no copay at preferred, standard, or standard mail-order pharmacies. Tier 2 generic drugs also offer no copay when filled at preferred pharmacies or through standard mail order, though standard retail pharmacies charge a $15 copay for a one-month supply. Tier 3 preferred brand drugs have a $40 copay for a one-month supply at preferred pharmacies, while Tier 4 non-preferred drugs carry a $90 copay. Choosing a standard pharmacy increases these one-month copays to $47 for Tier 3 and $100 for Tier 4. For Tier 5 specialty drugs, the plan requires a 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Select Health Medicare + Kroger (HMO) plan offers affordable coverage with no copays and no coinsurance for primary care, specialist visits, preventive services, and outpatient hospital care. For inpatient hospital stays, you will pay a low $50 daily copay for days one through four, with no copays for additional days. Emergency room visits require a $150 copay, while urgent care visits carry a $20 copay with no coinsurance. Routine dental, vision, and hearing exams are also covered with no copays, alongside benefits for eyewear and prescription hearing aids. Home health services are available with no copay, while dialysis and durable medical equipment require a 20% coinsurance with no copay. Skilled nursing facility stays require daily copays starting at $20 for the first 20 days with no coinsurance.
Inpatient Hospital See details
Select Health Medicare + Kroger (HMO) covers inpatient acute hospital stays with no coinsurance, a $50 daily copay for days 1 to 4, and no copay for days 5 and beyond. Inpatient psychiatric care is covered with no coinsurance, a $120 daily copay for days 1 to 10, and no copay for days 11 to 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Select Health Medicare + Kroger (HMO) covers outpatient hospital, ambulatory surgical center, and blood services with no copays and no coinsurance. Outpatient substance abuse services are also covered with no coinsurance, though individual sessions require a $25 copay and group sessions require a $10 copay.
Partial Hospitalization See details
Select Health Medicare + Kroger (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required, and a referral may also be needed depending on the provider.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Select Health Medicare + Kroger (HMO) plan, with ground and air ambulance services requiring a $275 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, but trips to any health-related location are not covered.
Emergency Services See details
Select Health Medicare + Kroger (HMO) covers emergency services with a $150 copay and urgently needed services with a $20 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $20 to $275.
Primary Care See details
Select Health Medicare + Kroger (HMO) covers primary care, specialist visits, therapy services, and telehealth with no copay and no coinsurance, while opioid treatment requires a $30 copay and no coinsurance. Mental health and psychiatric services feature no coinsurance with copays of $10 for group and $15 for individual sessions, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Select Health Medicare + Kroger (HMO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered, as services like health education, weight management, personal emergency response systems, in-home safety assessments, and therapeutic massages are not covered.
Hearing Services See details
Hearing services are partially covered by Select Health Medicare + Kroger (HMO), offering one routine exam and fitting evaluation yearly with no deductible, no copay, and no coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from $699 to $999, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Select Health Medicare + Kroger (HMO) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam and one refraction exam per year. Eyewear is partially covered with no copay or coinsurance up to a $200 annual limit for contact lenses, upgrades, and one complete pair of eyeglasses, though individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services are partially covered by Select Health Medicare + Kroger (HMO), with implant services and orthodontics being excluded from coverage. Covered preventive and diagnostic services have no copay and no coinsurance up to a $1,250 yearly maximum, while covered comprehensive services require no copay and 20% to 50% coinsurance.
Home Infusion bundled Services See details
Select Health Medicare + Kroger (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, chemotherapy, radiation, and other Part B drugs have no coinsurance to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Select Health Medicare + Kroger (HMO) covers Dialysis Services with no copay and a 20% coinsurance, and a referral is required.
Medical Equipment See details
Select Health Medicare + Kroger (HMO) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though prior authorization is required. This benefit is partially covered because diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Select Health Medicare + Kroger (HMO) partially covers diagnostic and radiological services, requiring referrals and prior authorization for covered services. Diagnostic procedures and diagnostic radiological services have no copay and no coinsurance, therapeutic radiological services carry a 20% coinsurance, and lab services and outpatient x-ray services are not covered.
Home Health Services See details
Select Health Medicare + Kroger (HMO) covers Home Health Services with no copay and no coinsurance. Both prior authorization and a referral are required to access these services.
Cardiac Rehabilitation Services See details
Select Health Medicare + Kroger (HMO) covers some services under Cardiac Rehabilitation Services with no copay and no coinsurance, requiring prior authorization and a referral. However, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Select Health Medicare + Kroger (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20, a $218 daily copay for days 21 through 40, and no copay for days 41 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Select Health Medicare + Kroger (HMO) partially covers other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance, though prior authorization is required. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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