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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 2025, 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 Bonneville County. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $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 $6750.00 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 has a $200 deductible for prescription drugs. After the deductible is met, you will pay the following costs for drugs in each tier. For preferred generic drugs, you will pay no copay at standard or mail order pharmacies. For standard generic drugs, you will pay 25% coinsurance. For preferred brand drugs, you will pay 38% coinsurance, and for non-preferred drugs, you will pay 30% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays and coinsurance depending on the service. Emergency and ambulance services are covered with copays, and primary care, hearing, vision, and dental services are also included, each with its own copay structure. This plan also covers home health services with no copay, and offers additional benefits like transportation, medical equipment, and diagnostic services. However, certain services such as cardiac rehabilitation, additional hours of care, and some dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, there is a $310 copay for days 1-6 and no copay for days 7-90; for Inpatient Hospital Psychiatric, there is also a $310 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services with a 20% coinsurance and a copay between $30 and $350, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with a $250 copay, and Outpatient Substance Abuse Services with a copay between $15 and $25 for individual or group sessions. Outpatient Blood Services are also covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Essential (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Select Health Medicare Essential (HMO) plan. Ground and Air Ambulance Services have a $350 copay, with no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, while 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. Emergency Services has a $125 copay and no coinsurance, Urgently Needed Services has a $55 copay and no coinsurance, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, a $55 copay for Worldwide Urgent Coverage, and a $350 copay for Worldwide Emergency Transportation, with no coinsurance for any service.
Primary Care See details
The Select Health Medicare Essential (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, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, and routine chiropractic care is not covered, while physician specialist services have a $30 copay. Individual and group mental health sessions have copays of $25 and $15 respectively, while routine foot care and Medicare-covered podiatry services have a $30 copay. Physical therapy and speech-language pathology services have a $45 copay, and additional telehealth benefits have a copay between $0 and $30.
Preventive Services See details
The Select Health Medicare Essential (HMO) plan covers preventive services, including annual physical exams, health education, in-home safety assessments, medical nutrition therapy, weight management programs, nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers, 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 with a $30 copay. Prescription hearing aids are covered with a copay between $425 and $1899, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Select Health Medicare Essential (HMO) plan covers vision services, including eye exams with a $30 copay, and eyewear. Eyewear includes contact lenses and eyeglasses (lenses and frames), and has a combined maximum benefit of $200 per year. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $30 copay, and other services like oral exams, dental x-rays, and cleanings, each with 1 visit every six months. Restorative, adjunctive general, removable prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, and oral and maxillofacial surgery services are covered with 20% coinsurance, while fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare Essential (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered items. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, and Durable Medical Equipment for use outside the home, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Select Health Medicare Essential (HMO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $50, while Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $350, and Therapeutic Radiological Services have a copay of $80. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Select Health Medicare Essential (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Select Health Medicare Essential (HMO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Select Health Medicare Essential (HMO) plan, but require prior authorization. There is no copay for days 1-20 and days 56-100, but there is a $214 copay for days 21-55. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Select Health Medicare Essential (HMO) plan covers Over-the-Counter (OTC) Items and Meal Benefits. 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 are not covered.
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