2027 Medicare Advantage plan
Select Health Medicare Veterans (HMO): 2027 benefits and costs
Select Health HMO
CMS plan ID: H1994-016-0 · Plan year: 2027
Select Health Medicare Veterans (HMO) is a 2027 Medicare Advantage plan offered by Select Health. It is listed in Utah.
2027 plan costs at a glance
Monthly plan premium$0.00
In-network medical out-of-pocket maximum$6,700.00
- Organization
- Select Health
- Plan organization
- SELECTHEALTH, INC.
- Parent company
- Intermountain Health Care, Inc.
- Plan type
- HMO
- Part C premium
- $0.00
- Prescription drug coverage
- No
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
- Monthly Part B premium after plan reduction
- $99.50 (estimated)$209.50 standard premium less $110.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- In-network medical deductible
- None
- In-network medical maximum
- $6,700.00
Applies to certain in-network supplemental services.
- Part B premium reduction
- $110.00
2027 benefit summary
Doctor visits and medical care
| Service | In-network | What to know |
|---|---|---|
| Primary care doctor | $0
| |
| Specialist visit | $50.00 copay
|
|
| Telehealth | $0.00 to $50.00 copay
|
|
| Emergency care | $130.00 copay | |
| Urgent care | $50.00 copay | |
| Home health | $0
|
|
| Dialysis | 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
|
|
| Kidney disease education services | $0
|
|
| Medicare-covered chiropractic | $15.00 copay
|
|
| Medicare-covered foot care | $50.00 copay
|
|
| Other health professionals | $0.00 to $50.00 copay
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–5: $500.00 copay per day Days 6–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–5: $400.00 copay per day Days 6–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | What to know |
|---|---|---|
| Outpatient hospital care | $50.00 to $400.00 copay; 20% coinsurance
| |
| Hospital observation services | $400.00 copay
| |
| Ambulatory surgical center | $300.00 copay
|
|
| Outpatient blood | $0
|
|
Tests, imaging and laboratory services
| Service | In-network | What to know |
|---|---|---|
| Diagnostic procedures and tests | $0.00 to $50.00 copay; 0% to 20% coinsurance
|
|
| Laboratory services | $0.00 to $50.00 copay
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $300.00 copay
|
|
| Therapeutic radiology | 20% coinsurance
|
|
| X-rays | $0
|
|
Mental health and substance use treatment
| Service | In-network | What to know |
|---|---|---|
| Partial hospitalization | $155.00 copay
|
|
| Intensive outpatient program | $155.00 copay
|
|
| Substance use treatment, individual sessions | $25.00 copay
|
|
| Substance use treatment, group sessions | $15.00 copay
|
|
| Opioid treatment program | 10% coinsurance
|
|
| Mental health, individual sessions | $25.00 copay
|
|
| Mental health, group sessions | $15.00 copay
|
|
| Psychiatry, individual sessions | $25.00 copay
|
|
| Psychiatry, group sessions | $15.00 copay
|
|
Therapy and rehabilitation
| Service | In-network | What to know |
|---|---|---|
| Occupational therapy | $20.00 copay
|
|
| Physical and speech therapy | $20.00 copay
|
|
| Cardiac rehabilitation | $0
|
|
| Intensive cardiac rehabilitation | $0
|
|
| Pulmonary rehabilitation | $0
|
|
| Supervised exercise for peripheral artery disease | $0
|
|
Ambulance, medical equipment and supplies
| Service | In-network | What to know |
|---|---|---|
| Ground ambulance | $300.00 copay
|
|
| Air ambulance | 20% coinsurance
|
|
| Durable medical equipment | 0% to 20% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
|
|
| Medical supplies | 20% coinsurance
|
|
| Diabetic supplies | $0
|
|
| Diabetic shoes and inserts | 20% coinsurance
|
|
| Diabetic monitors | $0
|
|
Dental benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered dental | $50.00 copay | |
| Oral examsAdditional plan benefit | $0 | |
| Dental X-raysAdditional plan benefit | $0 | |
| Other diagnostic dentalAdditional plan benefit | $0 | |
| Dental cleaningAdditional plan benefit | $0 | |
| Other preventive dentalAdditional plan benefit | $0 | |
| Restorative dental careAdditional plan benefit | 20% coinsurance | |
| Root canal treatment (endodontics)Additional plan benefit | 20% coinsurance | |
| Gum treatment (periodontics)Additional plan benefit | 20% coinsurance | |
| Removable dentures (prosthodontics)Additional plan benefit | 20% coinsurance | |
| Maxillofacial prostheticsAdditional plan benefit | 20% coinsurance | |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 20% coinsurance | |
| Oral surgeryAdditional plan benefit | 20% coinsurance | |
| Other dental servicesAdditional plan benefit | 20% coinsurance |
Vision benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered eye exams | $50.00 copay
|
|
| Routine eye examsAdditional plan benefit | $0 |
|
| Medicare-covered eyewear | $0
|
|
| Contact lensesAdditional plan benefit | $0 |
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0 |
|
Hearing benefits
| Service | In-network | What to know |
|---|---|---|
| Medicare-covered hearing exams | $50.00 copay
|
|
| Routine hearing examsAdditional plan benefit | $0 |
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 |
|
| Prescription hearing aids (all types)Additional plan benefit | $699.00 to $999.00 copay
|
|
Extra benefits
| Service | In-network | What to know |
|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0
| |
| Limited-duration mealsAdditional plan benefit | $0
|
|
| Annual physical examAdditional plan benefit | $0
|
|
| Fitness benefitAdditional plan benefit | $0
|
|
Allowances and optional benefits
Wellness Your Way
One shared limit covers the listed services, not a separate allowance for each service.
- Services sharing this allowance
- Health Education; Nutritional/Dietary Benefit; Fitness Benefit; Weight Management Programs
- How benefits are provided
- Debit Card; Reimbursement
- Advance choice of benefits required
- No
- Shared benefit limit
- $360.00
- How often this limit applies
- Every year
- Shared limit on visits or trips
- No
Prescription drug coverage
This plan does not include a Part D prescription drug benefit.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.