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Select Health Medicare Essential (HMO)

H1994 - 012 - 0
4 out of 5 stars (4 / 5)

select-health medicare provider logo

Select Health Medicare Essential (HMO) is a Medicare Advantage Plan by Select Health.

This page features plan details for 2025 Select Health Medicare Essential (HMO) H1994 – 012 – 0 available in Clark and Nye Counties.

Locations

Select Health Medicare Essential (HMO) is offered in the following locations.

Clark County, Nevada
Nevada
Nye County, Nevada

Click to see more locations

Plan Overview

Select Health Medicare Essential (HMO) offers the following coverage and cost-sharing.

Insurer:Select Health
Health Plan Deductible:$0
MOOP:$900 In-network
Drugs Covered:Yes

Ready to sign up for Select Health Medicare Essential (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

Select Health Medicare Essential (HMO) qualifies for a monthly Medicare Give Back Benefit of $3.00.

Premium Reduction:$3.00

Premium Breakdown

Select Health Medicare Essential (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $3.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Select Health Medicare Essential (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Select Health Medicare Essential (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Implant Services
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • 0-20% coinsurance (Authorization Required, Referral Required)
  • Lab services
    • $0 copay (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • $0-60 copay (Authorization Required, Referral Required)
  • Outpatient x-rays
    • $0 copay (Authorization Required, Referral Required)

Doctor visits

  • Specialist
    • $0 copay (Authorization Required, Referral Required)
  • Primary
    • $0 copay

Emergency care/Urgent care

  • Emergency
    • $140 copay per visit (always covered)
  • Urgent care
    • $10 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • $0 copay (Referral Required)
  • Routine foot care
    • $0 copay (Limits Apply, Referral Required)

Ground ambulance

    • $200 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • $0 copay (Limits Apply)
  • Hearing aids
    • $99-699 copay
  • Medicare-Covered Hearing Exam
    • $0 copay
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • $0 copay (Authorization Required, Referral Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $900 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • $0 copay (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit
    • $15 copay (Referral Required)
  • Outpatient group therapy visit with a psychiatrist
    • $10 copay (Referral Required)
  • Inpatient hospital – psychiatric
    • $0 copay (Authorization Required, Referral Required)
  • Outpatient group therapy visit
    • $10 copay (Referral Required)
  • Outpatient individual therapy visit with a psychiatrist
    • $15 copay (Referral Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $0 copay (Authorization Required, Referral Required)

Preventive care

    • $0 copay

Rehabilitation services

  • Occupational therapy visit
    • $0 copay (Authorization Required, Referral Required)
  • Physical therapy and speech and language therapy visit
    • $0 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $125 per day for days 21 through 100 (Authorization Required, Referral Required)

Transportation

    • $0 copay (Limits Apply, Authorization Required, Referral Required)

Vision

  • Eyeglass frames
    • Not covered
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply)
  • Upgrades
    • $0 copay (Limits Apply)
  • Contact lenses
    • $0 copay (Limits Apply)
  • Other
    • $0 copay (Limits Apply)
  • Routine eye exam
    • $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Select Health Medicare Essential (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Select Health Medicare Essential (HMO)? See 2025 Select Health Medicare Essential (HMO) at MedicareAdvantageRX.com.

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