A non-government entity
Select Health Medicare + Kroger (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare + Kroger (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 + Kroger (HMO) in 2025, please refer to our full plan details page.
Select Health Medicare + Kroger (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 + Kroger (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 + Kroger (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 + Kroger (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 $5400.00 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 + Kroger (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies and a $0 copay through standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Select Health Medicare + Kroger (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays and coinsurance, and coverage for ambulance and emergency services with copays. The plan also covers primary care, preventive services, hearing exams, vision services, dental services, and home health services. Additional benefits include coverage for partial hospitalization, home infusion services, dialysis services, medical equipment, and diagnostic and radiological services. This plan also covers skilled nursing facilities, cardiac rehabilitation services, and other services, such as over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 5 days, there is a $300 copay per admission or stay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a 20% coinsurance and a copay between $30 and $275, observation services with a $275 copay, ambulatory surgical center services with a $175 copay, outpatient substance abuse services with a copay between $25 and $35, and outpatient blood services. Outpatient blood services have an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the plan, but requires prior authorization. You will have a $105 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Select Health Medicare + Kroger (HMO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services are covered with a $20 copay, but routine care is not covered. Individual and Group Sessions for Mental Health and Psychiatric Specialty Services have a copay between $25 and $35. Podiatry Services have a $30 copay. Other Health Care Professional services have a copay between $0 and $30. Additional Telehealth Benefits have a copay between $0 and $30. Opioid Treatment Program Services have 10% coinsurance.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and other preventive services, are covered. Additional services include health education, in-home safety assessments, Medical Nutrition Therapy (MNT), nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, home and bathroom safety devices and modifications, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. 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 exams are covered with a $30 copay, and also include routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered with a copay between $325 and $1799, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Select Health Medicare + Kroger (HMO) covers vision services, including routine eye exams with a $30 copay. Eyewear is covered with a combined maximum of $200 per year, and contact lenses are also covered. Eyeglass lenses and frames are not covered.
Dental Services See details
The Select Health Medicare + Kroger (HMO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic, preventive, restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery; a $30 copay applies for Medicare dental services, and the plan has a $2,500 annual maximum for other dental services. Maxillofacial prosthetics, implant services, 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 by the Select Health Medicare + Kroger (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, but DME for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay of up to $30 and coinsurance up to 20%, and Diagnostic Radiological Services with a copay up to $175.00. Outpatient X-Ray Services have no copay, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the Select Health Medicare + Kroger (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit does require authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. 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 the Select Health Medicare + Kroger (HMO) plan with prior authorization required. For days 1-20 and 56-100, there is no copay, while days 21-55 have a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for 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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