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 Delta and Mesa Counties. 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 $0.10. 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, you will pay no copay for up to a three-month supply at standard pharmacies or through standard mail order. Tier 2 generic drugs also have no copay when filled through standard mail order, while standard pharmacies charge a copay ranging from $6 to $18 depending on the supply duration. For higher-tier prescriptions, Tier 3 preferred brand drugs require a copay of $47 for a one-month supply up to $141 for a three-month supply at both standard pharmacies and mail order. Tier 4 non-preferred drugs carry a copay of $100 for one month up to $300 for three months through these same channels. Specialty tier drugs in Tier 5 require a 33% coinsurance for a one-month supply at standard pharmacies and through standard mail order.
Additional Benefits
The Select Health Medicare Essential (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. For specialist visits, patients will pay copays ranging from $25 to $50, while inpatient hospital stays require a $375 daily copay for the first five days and no copay thereafter. Emergency care is available with a $130 copay, and outpatient services generally carry a 20% coinsurance alongside copays up to $275. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,500 annual limit and a $300 yearly eyewear allowance with no copay or coinsurance. Additionally, members benefit from routine hearing exams with a $45 copay, a $510 annual allowance for over-the-counter items with no copay, and up to 24 one-way transportation trips per year with no copay. Skilled nursing facility stays are also covered, featuring no copay for the first 20 days.
Inpatient Hospital See details
Select Health Medicare Essential (HMO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 5 and no copay for days 6 to 90 per stay. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Select Health Medicare Essential (HMO) covers outpatient hospital services with a 20% coinsurance and copays ranging from no copay up to $275, while observation services require a $275 copay per stay and a 20% coinsurance. Ambulatory surgical center services carry a $175 copay with no coinsurance, outpatient substance abuse sessions require a $25 or $45 copay with no coinsurance, and outpatient blood services are fully covered with no copay or coinsurance.
Partial Hospitalization See details
Select Health Medicare Essential (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Select Health Medicare Essential (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance, requiring 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, but transportation to any health-related location is not covered.
Emergency Services See details
Select Health Medicare Essential (HMO) covers emergency services with a $130 copay and urgently needed services with a $45 copay, with no coinsurance for either benefit 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, $45, and $350, respectively.
Primary Care See details
Select Health Medicare Essential (HMO) provides primary care physician visits and opioid treatment services with no copay and no coinsurance. Specialist visits, mental health sessions, podiatry, and physical, occupational, and speech therapies are covered with copays ranging from $25 to $50 and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Select Health Medicare Essential (HMO) partially covers preventive services with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and fitness benefits. Non-covered sub-services include health education, in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Select Health Medicare Essential (HMO) covers routine hearing exams and fittings with a $45 copay and no coinsurance, and prescription hearing aids with copays ranging from $325 to $1,799 and no coinsurance. Hearing services are partially covered under this plan, as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Select Health Medicare Essential (HMO) covers vision services with a $45 copay and no coinsurance for annual eye exams, and no copay or coinsurance for eyewear under a $300 annual allowance. This benefit is partially covered because contact lenses and complete eyeglasses are covered, but individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Select Health Medicare Essential (HMO) partially covers dental services, offering a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $2,500 yearly maximum. 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 is required. Covered Medicare Part B insulin drugs have a $35 copay, while Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered under the Select Health Medicare Essential (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Select Health Medicare Essential (HMO) covers medical equipment with no copay, but prior authorization is required. Durable medical equipment carries a 0% to 20% coinsurance, while prosthetics, medical supplies, and diabetic shoes or inserts require a 20% coinsurance, though diabetic supplies themselves are not covered.
Diagnostic and Radiological Services See details
Select Health Medicare Essential (HMO) partially covers diagnostic and radiological services, as lab services and outpatient X-ray services are not covered. Covered diagnostic procedures require prior authorization and carry no coinsurance with copays ranging from no copay to $45, while covered radiological services require prior authorization and have no coinsurance, with no copay for diagnostic radiology and an $85 copay for therapeutic radiology.
Home Health Services See details
Select Health Medicare Essential (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Select Health Medicare Essential (HMO) covers Cardiac Rehabilitation Services with no coinsurance, although prior authorization is required. While some services are covered, specific programs including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered, with copays ranging from $15 to $25.
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 preceding three-day hospital stay. There is no copay for days 1 through 20 and days 56 through 100, a $218 daily copay for days 21 through 55, and additional days beyond the standard 100 days are not covered.
Other Services See details
Select Health Medicare Essential (HMO) partially covers other services, which excludes acupuncture. Covered benefits include over-the-counter (OTC) items up to $510 per year and a chronic illness meal benefit, both available with no copay and no coinsurance.
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