A non-government entity
Select Health Medicare Wellness (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare Wellness (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 Wellness (HMO) in 2026, please refer to our full plan details page.
Select Health Medicare Wellness (HMO) is a HMO plan offered by Intermountain Health Care, Inc. available for enrollment in 2026 to people living in Clark and Nye 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 Wellness (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 Wellness (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 Wellness (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. Additionally, this plan comes with a Part B Premium reduction of $2.30. You must continue to pay paying your reduced 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 $1250.00 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 Wellness (HMO) plan features an annual drug deductible of $200. For prescription coverage, Tier 1 preferred generic drugs have no copay for up to a three-month supply at standard pharmacies and through standard mail order. Tier 2 generic drugs are also available with no copay through standard mail order, or for a low copay starting at $10 for a one-month supply at standard pharmacies. Higher tier medications require coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs carry a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 30% coinsurance at standard pharmacies and through standard mail order. These coinsurance rates apply to up to a three-month supply, except for Tier 5 specialty drugs which are limited to a one-month supply.
Additional Benefits
The Select Health Medicare Wellness (HMO) plan offers robust core medical coverage, featuring no copays or coinsurance for inpatient acute hospital stays, primary care visits, and specialist consultations. Outpatient surgery at ambulatory surgical centers and routine preventive services, like annual physicals, also come with no copay or coinsurance. For emergency situations, members pay a $150 copay, which is waived if admitted, while urgent care requires a $25 copay. This plan also includes essential specialty benefits, such as dental coverage with no copay for preventive care up to a $1,000 annual limit and a 50% coinsurance for comprehensive services. Vision and hearing benefits feature no-copay routine exams, alongside a $150 annual eyewear allowance and prescription hearing aid copays ranging from $699 to $999. Additionally, members receive a valuable over-the-counter benefit of up to $175 every three months with no copay or coinsurance.
Inpatient Hospital See details
Select Health Medicare Wellness (HMO) covers inpatient acute hospital stays with no copay, no coinsurance, and unlimited days, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are covered with no coinsurance, requiring a $120 daily copay for days 1 through 10 and no copay for days 11 through 90.
Outpatient Services See details
Select Health Medicare Wellness (HMO) covers outpatient hospital services with no copay and 0% to 20% coinsurance, and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse services feature no coinsurance with a $25 copay for individual sessions and a $15 copay for group sessions, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the Select Health Medicare Wellness (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization and referrals are required for this benefit.
Ambulance and Transportation Services See details
Select Health Medicare Wellness (HMO) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Select Health Medicare Wellness (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $25 to $300.
Primary Care See details
Select Health Medicare Wellness (HMO) provides primary care, specialist, therapy, and routine podiatry services with no copay and no coinsurance. Mental health and psychiatric sessions require a $10 to $15 copay, opioid treatment has a $30 copay, both with no coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by Select Health Medicare Wellness (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and diabetes self-management. However, additional preventive benefits are only partially covered, excluding in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Select Health Medicare Wellness (HMO), offering one routine exam and fitting evaluation annually with no copay or coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $699 to $999, though OTC hearing aids and prescription inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by Select Health Medicare Wellness (HMO) with no copay, no coinsurance, and no deductible, featuring one routine eye exam and one refraction exam per year. Eyewear is covered up to a $150 annual limit, though individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Select Health Medicare Wellness (HMO) provides partially covered dental services with a $1,000 annual limit on preventive and diagnostic care, which features no copay and no coinsurance. Covered comprehensive services require no copay and a 50% coinsurance, while implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Select Health Medicare Wellness (HMO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, covered Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Select Health Medicare Wellness (HMO) plan with no copay and a 20% coinsurance, though a referral is required to receive these services.
Medical Equipment See details
Select Health Medicare Wellness (HMO) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts with no copay and a 20% coinsurance, though prior authorization is required. Diabetic equipment is partially covered under this plan, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Select Health Medicare Wellness (HMO) partially covers diagnostic and radiological services, with prior authorization and referrals required. Covered diagnostic procedures and diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services require a copay and 20% coinsurance; however, lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by Select Health Medicare Wellness (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered under the Select Health Medicare Wellness (HMO) plan, which includes intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Select Health Medicare Wellness (HMO) with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. Covered stays require no copay for days 1 to 20 and 41 to 100, and a $218 daily copay for days 21 to 40, with prior authorization and a referral required.
Other Services See details
Select Health Medicare Wellness (HMO) partially covers other services, offering a chronic illness meal benefit and up to $175 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture and nicotine replacement therapy are not covered, and prior authorization is required for the meal benefit.
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