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 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 Delta and Mesa Counties. 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 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 has an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay a $6 copay at a standard pharmacy for preferred generic drugs, while you will pay a $0 copay for preferred generic drugs through mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), your Part D costs are $0.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $250 copay for days 1-5, and no copay for days 6-90. Outpatient services include copays from $25-$275, and emergency services have copays between $40 and $125. The plan also covers primary care visits with copays between $20 and $35, along with preventive, hearing, vision, and dental services. Hearing exams have a $35 copay, vision exams also have a $35 copay, and dental services have a $35 copay. The plan also provides coverage for home health services, medical equipment, and dialysis services, and includes coverage for ambulance and transportation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including acute and psychiatric services, with a $250 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a 20% coinsurance and a copay between $35 and $275, Observation Services have a $275 copay, Ambulatory Surgical Center (ASC) Services have a $175 copay, Individual Outpatient Substance Abuse Sessions have a $35 copay, and Group Outpatient Substance Abuse Sessions have a $25 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Select Health Medicare Essential (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation services to a plan-approved health-related location. Ground and air ambulance services have a copay of $275, and there is no coinsurance. 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 Select Health Medicare Essential (HMO). Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Select Health Medicare Essential (HMO) covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a copay of $35 for individual sessions and $25 for group sessions, Podiatry Services with a $35 copay, Other Health Care Professional services with a copay between $0 and $35, Psychiatric Services with a copay of $35 for individual sessions and $25 for group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services with 10% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, 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, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Personal Emergency Response System (PERS), 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, 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 include hearing exams with a $35 copay, and coverage for routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids (all types) are covered with a copay between $325 and $1799, but prescription hearing aids for the inner ear, outer ear, and over-the-ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Select Health Medicare Essential (HMO) plan covers vision services, including routine eye exams with a $35 copay, and other eye exam services, with a limit of one exam per year. Eyewear is covered with a combined maximum benefit of $300 every year for contact lenses, eyeglasses (lenses and frames), and upgrades, while eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $35 copay, and other dental services with a $3,000 annual maximum. Oral exams, dental x-rays, other diagnostic and preventive services, and fluoride treatments have no copay, while other services such as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 by the Select Health Medicare Essential (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, is covered by Select Health Medicare Essential (HMO). DME has a coinsurance between 0-20% with no copay, while Prosthetics/Medical Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance with no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay of up to $35 and coinsurance of at most 20%, and Diagnostic Radiological Services with a copay of up to $150. Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have no copay. Lab 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. However, additional hours of care and personal care services are not covered.
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, with prior authorization required. There is no copay for days 1-20 and 56-100, but there is a $214 copay for days 21-55. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF 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.
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