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 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 Northern, Southwest, and Central Utah. 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 $6325.00 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 drug deductible of $200 before coverage begins for higher-tier medications. Under this plan, you will pay no copay for Tier 1 preferred generic drugs at preferred and standard pharmacies, as well as through standard mail order. Tier 2 generic prescription copays are also highly affordable, starting at $3 for a one-month supply via standard mail order and $5 at preferred pharmacies. For brand-name and specialty medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance at preferred pharmacies and standard mail order, which increases to 25% at standard pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 30% to 35% coinsurance depending on your pharmacy choice and drug tier.
Additional Benefits
The Select Health Medicare + Kroger (HMO) plan offers robust medical coverage, featuring no copay for primary care visits and preventive services, while specialist visits require a $45 copay. For hospital care, inpatient stays carry a $500 copay for the first few days with no copay for subsequent days, and emergency room visits require a $130 copay that is waived if you are admitted. Outpatient hospital services generally range from a $45 to $400 copay with 20% coinsurance. This plan also includes key ancillary benefits, such as dental care up to a $1,500 annual limit with no copay for preventive services, and vision coverage featuring routine exams and a $200 annual eyewear allowance. Additionally, members can access routine hearing exams and prescription hearing aids with fixed copays and no coinsurance. Home health services are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Select Health Medicare + Kroger (HMO) covers inpatient hospital services with no coinsurance, requiring a $500 copay for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Select Health Medicare + Kroger (HMO) covers outpatient hospital services with a $45 to $400 copay and 20% coinsurance, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse services have a $25 to $30 copay and no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Select Health Medicare + Kroger (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Select Health Medicare + Kroger (HMO) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Select Health Medicare + Kroger (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, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $300 respectively.
Primary Care See details
Select Health Medicare + Kroger (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Other covered benefits, including physical, occupational, and mental health therapies, feature copays ranging from $25 to $45 with no coinsurance, though routine chiropractic care is not covered and opioid treatment requires a 10% coinsurance.
Preventive Services See details
Select Health Medicare + Kroger (HMO) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physical exams, health education, and fitness benefits. Several supplemental services are not covered, including personal emergency response systems, alternative therapies, therapeutic massage, and in-home support services.
Hearing Services See details
Select Health Medicare + Kroger (HMO) covers annual routine hearing exams and fitting evaluations with a $45 copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699.00 to $999.00, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Select Health Medicare + Kroger (HMO) covers vision services, offering routine eye exams for a $45 copay and no coinsurance, alongside eyewear with no copay or coinsurance up to a $200 annual limit. While contact lenses and complete eyeglasses are covered, individual eyeglass lenses and frames are not covered.
Dental Services See details
Select Health Medicare + Kroger (HMO) partially covers dental services up to a $1,500 annual limit, offering preventive care with no copay and no coinsurance, and Medicare-covered dental services for a $45 copay and no coinsurance. Other comprehensive services are covered with no copay and a 20% coinsurance, but fluoride treatments, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Select Health Medicare + Kroger (HMO) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, insulin, and other Part B drugs under this benefit carry coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare + Kroger (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Select Health Medicare + Kroger (HMO) with no copays, though prior authorization is required. Durable medical equipment carries a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic equipment is partially covered with a 20% coinsurance for therapeutic shoes and inserts, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Select Health Medicare + Kroger (HMO), with lab services and outpatient x-ray services not covered. Covered diagnostic procedures and tests require a copay of up to $45 and no coinsurance, while diagnostic radiological services have no copay or coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Select Health Medicare + Kroger (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by Select Health Medicare + Kroger (HMO) with no coinsurance and a $15 copay, subject to prior authorization. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Select Health Medicare + Kroger (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1–20 and 56–100, a $218 daily copay for days 21–55, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Select Health Medicare + Kroger (HMO) provides partial coverage for other services, offering a meal benefit for chronic illnesses with no copay and no coinsurance, subject to prior authorization. Acupuncture and Over-the-Counter (OTC) items are not covered under this benefit.
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