A non-government entity
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 2026, 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 Colorado Front Range. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 $4900.00 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 Essential (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 Essential (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for any supply length at standard pharmacies or through standard mail order. Tier 2 generic drugs cost $6 for a 1-month supply at standard pharmacies, but they have no copay when ordered through standard mail order. For Tier 3 preferred brands, you will pay a $47 copay for a 1-month supply, while Tier 4 non-preferred drugs require a $100 copay per month at standard pharmacies and mail order. Tier 5 specialty drugs are subject to a 33% coinsurance for a 1-month supply. This plan offers predictable tiered copayments and cost-saving mail-order options to help manage your prescription medication expenses.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers robust medical coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $375 daily copay for the first five days and no copay for days six through ninety, with no coinsurance required. Emergency room visits carry a $130 copay, while urgent care visits require a $35 copay, both of which feature no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage with no copay up to a $2,500 annual maximum. Vision services feature $35 eye exams and eyewear coverage with no copay up to a $300 annual limit, while routine hearing exams require a $35 copay. Additionally, members can take advantage of an over-the-counter benefit of up to $545 annually with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Select Health Medicare Essential (HMO) with no coinsurance and a copayment of $375 per day for days 1 through 5, followed by no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Select Health Medicare Essential (HMO) covers outpatient hospital services with a $0 to $200 copay and 20% coinsurance, and ambulatory surgical center services with a $100 copay and no coinsurance. Outpatient substance abuse services require a $15 to $25 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Select Health Medicare Essential (HMO) with a $140.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Select Health Medicare Essential (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance per trip, which requires prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Select Health Medicare Essential (HMO) covers emergency services with a $130 copay and urgently needed services with a $35 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $35, and $350, respectively.
Primary Care See details
Select Health Medicare Essential (HMO) covers primary care physician services and opioid treatment with no copay and no coinsurance. Specialist visits, mental health sessions, and therapy services are covered with copays ranging from $15 to $50 and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Select Health Medicare Essential (HMO) with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and kidney disease education. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-palliative care, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Select Health Medicare Essential (HMO) covers routine hearing exams and evaluations with a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $325 to $1,799, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Select Health Medicare Essential (HMO) offers partially covered vision services, featuring eye exams for a $35 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $300 annual limit. While contact lenses and complete eyeglasses are covered, individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Select Health Medicare Essential (HMO), offering most preventive and comprehensive services with no copay and no coinsurance up to a $2,500 annual maximum, though Medicare-covered dental services require a $35 copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Select Health Medicare Essential (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B drugs, such as chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin specifically requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by Select Health Medicare Essential (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Select Health Medicare Essential (HMO) covers medical equipment with no copays and prior authorization requirements, featuring no coinsurance to 20% coinsurance for durable medical equipment and 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with a 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Select Health Medicare Essential (HMO) partially covers diagnostic and radiological services, requiring prior authorization for covered services. Diagnostic procedures and tests range from no copay up to a $35 copay with no coinsurance, diagnostic radiological services feature no copay and no coinsurance, and therapeutic radiological services require an $85 copay with no coinsurance. Outpatient lab services and outpatient X-ray services are not covered under this plan.
Home Health Services See details
Home Health Services are covered under the Select Health Medicare Essential (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Select Health Medicare Essential (HMO) with no coinsurance and require prior authorization, though some services are covered while others are not. Specifically, standard cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation (with a $25 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Select Health Medicare Essential (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 to 20 and days 56 to 100, while a $218 daily copay applies for days 21 to 55.
Other Services See details
Select Health Medicare Essential (HMO) partially covers other services, providing over-the-counter (OTC) items up to $545 annually and chronic illness meal benefits with no copay and no coinsurance, though prior authorization is required for meals. Acupuncture is not covered under this benefit.
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