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 Northern, Southwest, and Central Utah. 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.
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 no drug deductible. Your prescription medication coverage will start immediately.
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:
Sign up for Select Health Medicare + Kroger (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Select Health Medicare + Kroger (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies, while standard generic drugs have a 16% coinsurance at preferred pharmacies. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Select Health Medicare + Kroger (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays and coinsurance, and coverage for emergency services. You'll find coverage for primary care, preventive services, hearing, vision, and dental services with varying copays. The plan also covers home health services, dialysis, and medical equipment, with some services subject to coinsurance. Additional benefits include coverage for ambulance and transportation services, home infusion, and skilled nursing facility stays with copays. It also offers over-the-counter items and meal benefits. However, it is important to note that certain services like acupuncture, orthodontics, and some types of home care are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $410 for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services are covered, with a copay of $350 for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, and Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $20-$350 copay and 20% coinsurance, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with a $275 copay, Outpatient Substance Abuse Services with a $20-$25 copay, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare + Kroger (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Select Health Medicare + Kroger (HMO) plan. Ground and Air Ambulance Services have a $280 copay, and there is no coinsurance; however, 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 by the Select Health Medicare + Kroger (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay, with no coinsurance for either. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $280 copay, all with no coinsurance.
Primary Care See details
The Select Health Medicare + Kroger (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 and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic, mental health specialty, podiatry, and psychiatric services have a $20 copay, while other health care professional services have a copay between $0 and $20; other services have a $20 copay, except for opioid treatment, which has a 10% coinsurance.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, as well as annual physical exams. Additional services covered include health education, in-home safety assessments, medical nutrition therapy, weight management programs, nutritional/dietary benefits, fitness benefits, remote access technologies, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit; however, 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 are covered, including hearing exams with a $20 copay. Prescription hearing aids are covered with a copay between $699 and $999, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services includes eye exams with a $20 copay, and covers routine eye exams and other eye exam services once per year. Eyewear benefits include contact lenses, eyeglasses (lenses and frames) once per year, and upgrades. Eyeglass lenses and 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. Fluoride Treatment, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For the other services, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Select Health Medicare + Kroger (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits include durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a coinsurance between 0% and 20% with no copay, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance with no copay, and diabetic therapeutic shoes/inserts have a coinsurance between 20% and 20% with no copay. Diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for Diagnostic Procedures/Tests with no copay and a coinsurance of at most 20%, and Diagnostic Radiological Services with a copay of at most $200.00. Therapeutic Radiological Services has a coinsurance of at most 20%, while 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 or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Select Health Medicare + Kroger (HMO), but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Select Health Medicare + Kroger (HMO) plan, but require prior authorization. For days 1-20 and days 56-100, there is no copay, while days 21-55 have a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, but does not cover 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. Meal Benefits require prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved