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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 Bonneville County. 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 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 $6750.00 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 $200 deductible for prescription drugs. After the deductible, you will pay coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay 0% coinsurance for preferred generic drugs at a preferred pharmacy, and 25% coinsurance at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Select Health Medicare + Kroger (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services include copays and coinsurance depending on the service. Emergency services and primary care visits have set copays, and preventive services are covered. This plan also covers hearing, vision, and dental services, with copays and coinsurance applying to specific services. Additionally, the plan includes coverage for home health services, medical equipment, and skilled nursing facilities, with different cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $405 copay for days 1-6, and no copay for days 7-90; there is also unlimited coverage for additional days. For Inpatient Hospital Psychiatric, you'll pay a $380 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $20-$350 copay and 20% coinsurance, observation services with a $350 copay, ambulatory surgical center services with a $250 copay, and outpatient substance abuse services with a $15-$25 copay depending on the session type. Outpatient blood services are also covered, with a waived 3-pint deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Select Health Medicare + Kroger (HMO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Select Health Medicare + Kroger (HMO) plan. Ground and air ambulance services have a $350 copay. Transportation Services to a plan-approved health-related location are covered, while transportation services to any other health-related location are 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 $55 copay, both with no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $350 copay, all with no coinsurance.
Primary Care See details
The Select Health Medicare + Kroger (HMO) plan covers Primary Care Physician Services, Chiropractic 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. Chiropractic services have a $20 copay, Occupational Therapy Services and Physical Therapy/Speech-Language Pathology Services have a $45 copay, Physician Specialist Services have a $20 copay, Individual and Group Mental Health and Psychiatric sessions have copays between $15 and $25, and Additional Telehealth Benefits have a copay between $0 and $20. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered by the Select Health Medicare + Kroger (HMO) plan, including Medicare-covered zero dollar preventive services, annual physical exams, health education, in-home safety assessments, medical nutrition therapy, nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. 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, 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 by the Select Health Medicare + Kroger (HMO) plan, including routine hearing exams with a $20 copay. Prescription hearing aids are covered, with a copay between $425 and $1899. Fitting/Evaluation for Hearing Aids is covered. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes eye exams with a $20 copay, and other eye exam services. Eyewear is covered, including contact lenses, eyeglasses (lenses and frames), and upgrades. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, and other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with a limit of one visit every six months. Restorative services, prosthodontics (removable and fixed), and oral and maxillofacial surgery have a 20% coinsurance, while orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment benefits are covered by Select Health Medicare + Kroger (HMO), with no copay. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Select Health Medicare + Kroger (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $35, while Diagnostic Radiological Services have a maximum copay of $350, and Therapeutic Radiological Services have a copay of $80. Lab Services and Outpatient X-Ray 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 requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Select Health Medicare + Kroger (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Select Health Medicare + Kroger (HMO). There is no copay for days 1-20 and days 56-100, but there is a $214 copay for days 21-55. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Select Health Medicare + Kroger (HMO) plan does not cover acupuncture or Dual Eligible SNPs with Highly Integrated Services. Over-the-Counter (OTC) Items and Meal Benefits are covered, with the meal benefit requiring prior authorization. The plan also covers Other 1 services, specifically St. Luke's Intensive Lifestyle Program. The plan also does not cover 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.
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