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 2026, 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 3.5 out of 5 stars in 2026.
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 $5900.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. You will pay no copay for Tier 1 preferred generic drugs at preferred, standard, and standard mail-order pharmacies. For Tier 2 generic drugs, copays start at $5 for a one-month supply at preferred pharmacies, while standard mail order offers these medications with no copay. Tier 3 preferred brand drugs require a $40 copay for a one-month supply at preferred and standard mail-order pharmacies, while Tier 4 non-preferred drugs have a $90 copay. Standard pharmacies carry slightly higher copays of $47 for Tier 3 and $100 for Tier 4 medications. Specialty drugs in Tier 5 require a 33% coinsurance for a one-month supply across preferred, standard, and standard mail-order services.
Additional Benefits
The Select Health Medicare + Kroger (HMO) plan offers affordable medical coverage, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. Specialist visits, urgent care, and emergency room services are accessible with flat copayments and no coinsurance. For inpatient hospital stays, members pay a daily copayment for the first few days, followed by no copay and no coinsurance for the remainder of their stay. Additional benefits include comprehensive dental services with no copay or coinsurance up to a $1,500 annual limit, alongside vision coverage featuring a $200 yearly allowance for eyewear. Members also benefit from hearing aid coverage with predictable copays and no cost for up to 24 one-way transportation trips per year to plan-approved locations. Outpatient services, diagnostic tests, and medical equipment are covered through a mix of flat copayments and coinsurance up to 20 percent.
Inpatient Hospital See details
Inpatient hospital care is covered by Select Health Medicare + Kroger (HMO) with no coinsurance, requiring a daily copay of $475 for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, followed by no copay for remaining days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Select Health Medicare + Kroger (HMO) covers outpatient hospital services with a $0 to $325 copay and 20% coinsurance, and ambulatory surgical center services with a $225 copay and no coinsurance. Outpatient substance abuse services require a $25 to $35 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Select Health Medicare + Kroger (HMO) plan with a $130.00 copay and no coinsurance. Prior authorization may be required depending on the services received.
Ambulance and Transportation Services See details
Select Health Medicare + Kroger (HMO) covers ground and air ambulance services with a $350 copay and no coinsurance per trip. Transportation benefits are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Select Health Medicare + Kroger (HMO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, featuring no coinsurance for either benefit and waived copays if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance, requiring a $130 copay for emergency care, a $50 copay for urgent care, and a $350 copay for emergency transportation.
Primary Care See details
Select Health Medicare + Kroger (HMO) provides primary care physician and opioid treatment services with no copay and no coinsurance, while specialist and routine podiatry visits require a $55 copay and no coinsurance. Physical, occupational, and speech therapies require copays of $50 to $75 with no coinsurance, mental health and psychiatric services have copays between $25 and $35 with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Select Health Medicare + Kroger (HMO) with no copay and no coinsurance for covered services like annual physical exams and kidney disease education. Sub-services not covered under this plan include In-Home Safety Assessments, Personal Emergency Response Systems (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 smoking and tobacco cessation counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services.
Hearing Services See details
Select Health Medicare + Kroger (HMO) covers hearing exams and fitting evaluations with a $55 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $325 to $1,799 for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Select Health Medicare + Kroger (HMO) covers vision services, offering annual routine eye exams for a $55 copay and no coinsurance, and eyewear with no copay or coinsurance up to a $200 yearly limit. This benefit is partially covered, as individual eyeglass lenses and individual eyeglass frames are not covered, though contact lenses and one complete pair of eyeglasses are covered each year with no deductible.
Dental Services See details
Select Health Medicare + Kroger (HMO) offers partially covered dental services with a $1,500 annual limit, featuring no copay and no coinsurance for covered preventive and comprehensive care such as cleanings, exams, and restorative services. Medicare-covered dental services require a $55 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Select Health Medicare + Kroger (HMO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, insulin, and other drugs feature coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare + Kroger (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Select Health Medicare + Kroger (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment is covered with no coinsurance to 20% coinsurance, while prosthetic devices, medical supplies, and diabetic shoes or inserts require 20% coinsurance. Diabetic equipment is only partially covered under this plan, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Select Health Medicare + Kroger (HMO) diagnostic and radiological services are partially covered and require prior authorization, with no coinsurance for any covered services. Diagnostic procedures and tests carry a copay ranging from $0 to $55, diagnostic radiology has no copay, and therapeutic radiology requires a copay starting at $85, while lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Select Health Medicare + Kroger (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Select Health Medicare + Kroger (HMO) with no coinsurance, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Select Health Medicare + Kroger (HMO) with no coinsurance, featuring no copay for days 1 to 20 and days 56 to 100, and a $218 daily copay for days 21 to 55. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Select Health Medicare + Kroger (HMO) partially covers other services, providing a meal benefit for chronic illnesses with no copay and no coinsurance, subject to prior authorization. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered.
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