Select Health Medicare Choice (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, with a copay of $330 for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered, with a copay of $330 for days 1-6 and no copay for days 7-90, but 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% coinsurance and a copay between $25 and $350, Observation Services with a $350 copay, Ambulatory Surgical Center Services with a $250 copay, and Outpatient Substance Abuse Services, with individual sessions having a $30 copay and group sessions having a $20 copay. Outpatient Blood Services are also covered.

Partial Hospitalization See details

Partial Hospitalization is covered by Select Health Medicare Choice (PPO), with a $55 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by Select Health Medicare Choice (PPO), including both ground and air ambulance services with a $350 copay, and transportation services to a plan-approved health-related location with up to 24 one-way trips per year. Transportation services to any health-related location are not covered. There is no coinsurance for any of these services.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $350 copay. There is no coinsurance for any of these services.

Primary Care See details

Select Health Medicare Choice (PPO) covers Primary Care, including primary care physician services, with no copay. Chiropractic services require prior authorization and have a $20 copay, but routine chiropractic care is not covered. Occupational therapy services have a $45 copay, while physician specialist services have a $25 copay. Mental health specialty services have a minimum copay of $15 for group sessions and a minimum copay of $25 for individual sessions. Podiatry services and routine foot care have a $25 copay, and you are allowed 6 visits per year. Other health care professional visits have a copay between $0 and $25. Psychiatric services have a minimum copay of $15 for group sessions and a minimum copay of $25 for individual sessions. Physical therapy and speech-language pathology services have a $45 copay and require authorization. Additional Telehealth Benefits have a copay between $0 and $25, and Opioid Treatment Program Services have no copay.

Preventive Services See details

Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, health education, in-home safety assessments, medical nutrition therapy, weight management programs, nutritional/dietary benefits, in-home support services, fitness benefits, remote access technologies, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, while 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, 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 include routine hearing exams with a $25 copay, and fitting/evaluation for hearing aids with 1 visit covered every year. Prescription hearing aids are covered, with copays between $425 and $1899, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.

Vision Services See details

The Select Health Medicare Choice (PPO) plan covers vision services including eye exams with a $25 copay, and eyewear with a combined maximum of $200 per year for both in-network and out-of-network services. Contact lenses are covered, but eyeglass lenses and frames are not covered.

Dental Services See details

The Select Health Medicare Choice (PPO) plan covers Medicare Dental Services with a $25 copay and also covers Other Dental Services. The plan covers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services, but does not cover Fluoride Treatment. Restorative, Adjunctive General, Prosthodontics (removable, fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery services are covered with 20% coinsurance, while Orthodontics is 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 a coinsurance between 0% and 20%. For other drugs, there is a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the Select Health Medicare Choice (PPO) plan, with a coinsurance of 20%.

Medical Equipment See details

Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies are covered. DME has a coinsurance between 0% and 20%, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and there is no copay for any of these services.

Diabetic Therapeutic Shoes/Inserts 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

Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a maximum copay of $50, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $350, and Therapeutic Radiological Services have a copay of $80, with Outpatient X-Ray Services not covered.

Home Health Services See details

Home Health Services are covered by the Select Health Medicare Choice (PPO) plan with no copay and no coinsurance, though authorization is required. However, Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the Select Health Medicare Choice (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20 and 56-100, there is no copay, and for days 21-55, the copay is $214.

Other Services See details

Other Services for the Select Health Medicare Choice (PPO) plan include coverage for Over-the-Counter (OTC) Items and Meal Benefits, although Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered. The OTC benefit does not have a maximum coverage amount and includes Naloxone coverage. The Meal Benefit requires prior authorization and is for chronic illness.