A non-government entity
Select Health Medicare Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Select Health Medicare Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Select Health Medicare Choice (PPO) in 2025, please refer to our full plan details page.
Select Health Medicare Choice (PPO) is a PPO plan offered by Intermountain Health Care, Inc. available for enrollment in 2025 to people living in Northern and Southwest Utah and Franklin County ID. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Select Health Medicare Choice (PPO) 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 Choice (PPO).
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 Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.00. 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 $100.00 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 combined Maximum Out-Of-Pocket cost of $9550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Choice (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Select Health Medicare Choice (PPO) plan has a $100 deductible for prescription drugs. In the initial coverage phase, after meeting your deductible, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, if you have a preferred generic drug, you will pay a $10 copay at a standard pharmacy, or a $5 copay via mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Select Health Medicare Choice (PPO) plan offers comprehensive coverage with varying costs for different services. Inpatient hospital stays have a copay, but the plan covers a wide range of outpatient services, including primary care, mental health, and substance abuse services. Emergency services and ambulance services are covered with copays, while preventive services and home health services are available with no copay. This plan also provides coverage for hearing, vision, and dental services, with copays for routine exams and hearing aids. Additionally, it covers home infusion, dialysis, medical equipment, and diagnostic services, with some services requiring coinsurance. The plan also offers Skilled Nursing Facility (SNF) services with varying copays depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $420 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $370 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while 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 copay of $15-$360 and 20% coinsurance, observation services with a $360 copay, ambulatory surgical center services with a $260 copay, and outpatient substance abuse services with a $15-$25 copay depending on the session type. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Select Health Medicare Choice (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Select Health Medicare Choice (PPO). Both ground and air ambulance services have a copay of $225, with no coinsurance. Transportation services to any 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 Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $40 copay, and Worldwide Emergency Transportation has a $225 copay; all services have no coinsurance.
Primary Care See details
Select Health Medicare Choice (PPO) covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services require prior authorization and have a $20 copay. Routine Chiropractic Care is not covered. Physical therapy and speech-language pathology services have a $30 copay. Additional Telehealth benefits have a copay between $0 and $15, and Opioid Treatment Program Services have a 10% coinsurance.
Preventive Services See details
The Select Health Medicare Choice (PPO) plan covers various preventive services, including Medicare-covered preventive services, annual physical exams, health education, in-home safety assessments, medical nutrition therapy, weight management programs, fitness benefits, remote access technologies, home and bathroom safety devices, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. This plan does not cover 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, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, and Counseling Services.
Hearing Services See details
Hearing services include routine hearing exams with a $15 copay, and fitting/evaluation for hearing aids with a copay. Prescription hearing aids are covered with a copay between $699 and $999 for all types of hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams with a $15 copay, as well as coverage for eyewear, including contact lenses and eyeglasses (lenses and frames). Eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services are covered under the Select Health Medicare Choice (PPO) plan with a $2,000 annual maximum. Medicare Dental Services have a $15 copay, while Fluoride Treatment, 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 with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Select Health Medicare Choice (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Diabetic Therapeutic Shoes/Inserts, is covered, with a 0-20% coinsurance for DME and 20% coinsurance for Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts. Medical Supplies have a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The Select Health Medicare Choice (PPO) plan covers diagnostic and radiological services, but lab services and outpatient X-ray services are not covered. Diagnostic Procedures/Tests have a copay of $0 to $15, and a coinsurance of up to 20%, while Diagnostic Radiological Services have a copay of $0 to $200. Therapeutic Radiological Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, 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 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 Choice (PPO) plan. For days 1-20, there is no copay, days 21-55 have a $214 copay, and days 56-100 have no copay.
Other Services See details
The Select Health Medicare Choice (PPO) plan does not cover 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items and meal benefits are covered, with the meal benefit requiring prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved