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Select Health Medicare Flex (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare Flex (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 Flex (HMO) in 2025, please refer to our full plan details page.
Select Health Medicare Flex (HMO) is a HMO plan offered by Intermountain Health Care, Inc. available for enrollment in 2025 to people living in Colorado Front Range and Western Slope. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Select Health Medicare Flex (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 Flex (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 Flex (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 $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:
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Drug Coverage
The Select Health Medicare Flex (HMO) plan has a $200 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For example, for a preferred generic drug at a standard pharmacy, you'll pay an $8 copay, while you will have no copay at a standard mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your covered drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Select Health Medicare Flex (HMO) plan offers comprehensive coverage with a variety of benefits. The plan includes coverage for inpatient hospital stays with a copay, as well as outpatient services, emergency services, and primary care visits with varying copays or coinsurance. Additional benefits include preventive services with no copay, hearing and vision services with copays, and dental services with a $3,000 annual maximum. The plan also covers home health services with no copay, and skilled nursing facility stays with a copay. Other services, such as over-the-counter items and meal benefits, are also included.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered. For inpatient hospital-acute, you will pay a $300 copay for days 1-5, and no copay for days 6-90. For inpatient hospital psychiatric, you will pay a $300 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 are not covered. Non-Medicare-covered stays and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and ambulatory surgical center (ASC) services, are covered. Outpatient hospital services have a 20% coinsurance and a copay between $25 and $250, observation services have a $250 copay, and ASC services have a $150 copay. Outpatient substance abuse services are also covered, with individual sessions having a $30 copay and group sessions having a $20 copay. Outpatient blood services are covered, with three pints waived from the deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Flex (HMO) plan, with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Select Health Medicare Flex (HMO) plan covers ambulance services, including ground and air ambulance, each with a copay of $275 and 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 under the Select Health Medicare Flex (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $40 copay, and Worldwide Emergency Transportation has a $275 copay; all services have no coinsurance.
Primary Care See details
The Select Health Medicare Flex (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $25 copay, mental health specialty services with a copay of $30 for individual sessions and $20 for group sessions, podiatry services with a $25 copay, other health care professional services with a copay between $0 and $25, psychiatric services with a copay of $30 for individual sessions and $20 for group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a 10% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
The Select Health Medicare Flex (HMO) plan covers a variety of preventive services, including Medicare-covered services with no copay, annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, home and bathroom safety devices and modifications, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. However, 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 are covered, including hearing exams with a $25 copay, and routine hearing exams, and fitting/evaluation for hearing aids are covered. Prescription Hearing Aids (all types) are covered, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay, and the plan also covers contact lenses, eyeglasses (lenses and frames), and upgrades. Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are covered, with a $3,000 maximum benefit per year. Medicare Dental Services have a $25 copay. Other dental services include oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics.
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, all requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare Flex (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Select Health Medicare Flex (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance, but Diabetic Supplies and Durable Medical Equipment for use outside the home are not covered.
Diagnostic and Radiological Services See details
The Select Health Medicare Flex (HMO) plan covers Diagnostic and Radiological Services. Diagnostic Procedures/Tests may have a copay of up to $25 and a coinsurance of up to 20%, while Diagnostic Radiological Services have a copay of up to $150. Therapeutic Radiological Services have a coinsurance of up to 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Select Health Medicare Flex (HMO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, 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, and there is a copay for Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Select Health Medicare Flex (HMO), but require prior authorization. For days 1-20 and 56-100, there is no copay, and for days 21-55, the copay is $214. Additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the Select Health Medicare Flex (HMO) plan include coverage for Over-the-Counter (OTC) Items and Meal Benefits, but not for Acupuncture or Dual Eligible SNPs with Highly Integrated Services. OTC items are covered and do not have a maximum coverage amount, and meal benefits require prior authorization. However, several additional services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and more.
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