A non-government entity
Select Health Medicare Active (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare Active (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 Active (HMO) in 2025, please refer to our full plan details page.
Select Health Medicare Active (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 Active (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 Active (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 Active (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 $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:
Sign up for Select Health Medicare Active (HMO)
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Drug Coverage
The Select Health Medicare Active (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay different amounts depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay $8 for a standard pharmacy for preferred generic drugs, while you pay no copay for preferred generic drugs through mail order. You will pay 25% coinsurance for standard and mail order standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Select Health Medicare Active (HMO) plan offers a range of benefits, including inpatient hospital stays with a $300 copay for days 1-5, and no copay for days 6-90, as well as coverage for various outpatient services with copays ranging from $35-$300. This plan also covers primary care, preventive services, and home health services with no copay, along with hearing, vision, and dental services. Additional benefits include ambulance services with a $275 copay, emergency services with a $125 copay, and partial hospitalization with a $105 copay. The plan provides coverage for home infusion, dialysis, and medical equipment, with varying copays and coinsurance. Skilled nursing facility services are covered with no copay for days 1-20, a $214 copay for days 21-55, and no copay for days 56-100.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, 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 also 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 Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $35-$300 copay and 20% coinsurance, Observation Services with a $300 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay, Individual Sessions for Outpatient Substance Abuse with a $40 copay, Group Sessions for Outpatient Substance Abuse with a $30 copay, and Outpatient Blood Services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Select Health Medicare Active (HMO) plan, requiring prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Select Health Medicare Active (HMO) plan. Both ground and air ambulance services have a copay of $275, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, including urgently needed services and worldwide emergency services. Emergency Services have a $125 copay, urgently needed services have a $40 copay, and 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
The Select Health Medicare Active (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 $35 copay), Mental Health Specialty Services (with a $40 copay for individual sessions and a $30 copay for group sessions), Podiatry Services (with a $35 copay), Other Health Care Professional services (with a copay between $0-$35), Psychiatric Services (with a $40 copay for individual sessions and a $30 copay for group sessions), Physical Therapy and Speech-Language Pathology Services (with a $30 copay), Additional Telehealth Benefits (with a copay between $0-$35), and Opioid Treatment Program Services (with 10% coinsurance). Routine Chiropractic Care is not covered.
Preventive Services See details
The Select Health Medicare Active (HMO) plan covers preventive services, including annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Additional preventive services are covered, but health education, personal emergency response systems, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription hearing aids are covered with a copay between $325 and $1799, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a $35 copay, and eyewear with a combined maximum benefit of $300 every year. Contact lenses are covered, and eyeglasses (lenses and frames) are covered with a limit of one pair per year.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $35 copay, and other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Orthodontic services are also covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery are covered, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
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. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Select Health Medicare Active (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%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a coinsurance between 20% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a copay of up to $35 and no coinsurance, and therapeutic radiological services with at most a 20% coinsurance. Outpatient X-ray services have a $10 copay, and lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Select Health Medicare Active (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Select Health Medicare Active (HMO) plan, 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 copays apply to some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required. You will have no copay for days 1-20, a $214 copay for days 21-55, and no copay for days 56-100.
Other Services See details
Other Services in the Select Health Medicare Active (HMO) plan includes coverage for Over-the-Counter items and Meal Benefits, with the latter requiring prior authorization. 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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