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inurance organization provider

Select Health

Plan ID: H1994-24-0

Select Health Medicare Flex (HMO)

2024 Select Health Medicare Flex (HMO) H19940240 is a Medicare Advantage plan with drug coverage. It has received a 5-out-of-5 star rating from CMS for 2024.

Learn more about Select Health Medicare Flex (HMO) H1994 - 024 - 0, including the health and drug services it covers, by reading our easy-to-use guide. Or contact a licensed insurance agent for help now.

5 / 5 stars for 2024

$25.00 /mo

Monthly premium

$0

Health deductible

$100.00

Drug deductible

$4200.00

Out-of-pocket maximum

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Overview Icon

Plan Overview

2024 Select Health Medicare Flex (HMO) H19940240 is a Local HMO offered in Ada, Boise, Canyon, Elmore and Gem Counties by Select Health. It has a monthly premium of $25.00.

Premium Breakdown

Standard Part B Premium

$174.70

Part B premium reduction

- $0

Monthly Plan Premium

$25.00

Total Premium:

$199.70

Note:

The standard Part B premium for 2024 is $174.70. Your Part B premium may differ based on factors including late enrollment, income, and disability status. Higher-income beneficiaries may pay an income-related monthly adjustment amount (IRMAA). The Part B premium is required to be paid by everyone enrolled in Medicare Part B.

Special needs plan type

No

Out-of-pocket maximum

$4200.00

Plan Organization:

Select Health

Plan Type:

Local HMO

Location:

Ada, Boise, Canyon, Elmore and Gem Counties

Drugs Covered:

Yes

Drug Formulary:

Pharmacies:

Doctor Choice:

Plan Doctors for Most Services

Doctors Link:

Deductibles

The amount you must pay each year before your plan starts to pay for covered services or drugs.

Health deductible

$0

Drug deductible

$100

Note:

This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs in certain tiers.

Other Plan Notes

  • This plan does not charge an annual deductible for all drugs. The $100.00 annual deductible only applies to drugs on certain tiers.

Sign up for Select Health Medicare Flex (HMO)

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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 Icon

Drug Coverage

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

Drug Benefit Type

Enhanced

Prescription drug deductible

$100.00

Increased initial coverage limit

No

Additional gap coverage

Yes

Part D Premium Reduction

This plan's premium may be reduced for you if you qualify for the low-income subsidy (also known as LIS or "Extra help"). The following is what you'll pay for with LIS.

Part D

LIS 25%

LIS 50%

LIS 75%

LIS Full

$25.00

$25.00

$25.00

$25.00

$25.00

Initial Coverage Phase

After you pay your $100.00 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 $4,660.00. Once you reach that amount, you will enter the next coverage phase.

30 Days
60 Days
90 Days

Tier

Preferred Pharmacy

Standard Pharmacy

Preferred Mail

Standard Mail

1. Preferred Generic

-

$0.00 copay

-

$0.00 copay

2. Standard Generic

-

$6.00 copay

-

$0.00 copay

3. Preferred Brand

-

$47.00 copay

-

$47.00 copay

4. Non-Preferred Drug

-

$100.00 copay

-

$100.00 copay

5. Specialty Tier

-

31%

-

31%

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.

30 Days
60 Days
90 Days

Tier

Preffered Pharmacy

Standard Pharmacy

Preffered Mail

Standard Mail

Preferred Generic)

-

$0.00 copay

-

$0.00 copay

Generic)

-

$6.00 copay

-

$0.00 copay

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

Generic Drugs

$4.15 copay or 5% (whichever costs more)

Brand-name

$10.35 copay or 5% (whichever costs more)

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Additional Benefits

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

Note:

Limits, Authorizations, and Referrals may apply for the benefits below. Contact the plan for details.

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Comprehensive dental

Non-routine services
$0 copay
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Diagnostic services
$0 copay
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Restorative services
$0 copay
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Endodontics
$0 copay
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Periodontics
$0 copay
Limit IconExclamation Icon
Extractions
$0 copay
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Prosthodontics, other oral/maxillofacial surgery, other services
$0 copay
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Preventive dental

Oral exam
$0 copay
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Cleaning
$0 copay
Limit Icon
Fluoride treatment
Not covered
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Dental x-ray(s)
$0 copay
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Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures
$0-20 copay or 0-20% coinsurance
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Lab services
$0 copay
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Diagnostic radiology services (eg, MRI)
$0-250 copay
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Outpatient x-rays
$0 copay
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Doctor visits

Primary
$0 copay
Specialist
$20 copay per visit
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Emergency care/Urgent care

Emergency
$100 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)
Additional Coverage Icon

Foot care (podiatry services)

Foot exams and treatment
$20 copay
Routine foot care
$20 copay
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Additional Coverage Icon

Ground ambulance

Service
$250 copay
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Hearing

Hearing exam
$20 copay
Fitting/evaluation
$0 copay
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Hearing aids
$0 copay
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Inpatient hospital coverage

Service
$300 per day for days 1 through 5 $0 per day for days 6 through 90
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Additional Coverage Icon

Outpatient hospital coverage

Service
$20-250 copay or 20% coinsurance per visit
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Additional Coverage Icon

Outpatient prescription drugs

Select Health Medicare Flex (HMO) does not provide this type of benefit.

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Optional benefits

Select Health Medicare Flex (HMO) does not provide this type of benefit.

Additional Coverage Icon

Medical equipment/supplies

Durable medical equipment (eg, wheelchairs, oxygen)
0-20% coinsurance per item
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Prosthetics (eg, braces, artificial limbs)
20% coinsurance per item
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Diabetes supplies
$0 copay
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Medicare Part B drugs

Chemotherapy
0-20% coinsurance
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Other Part B drugs
0-20% coinsurance
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Part B Insulin drugs
0-20% coinsurance (up to $35)
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Mental health services

Inpatient hospital - psychiatric
$300 per day for days 1 through 5 $0 per day for days 6 through 90
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Outpatient group therapy visit with a psychiatrist
$15 copay
Outpatient individual therapy visit with a psychiatrist
$25 copay
Outpatient group therapy visit
$15 copay
Outpatient individual therapy visit
$25 copay
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Preventive care

Service
$0 copay
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Rehabilitation services

Occupational therapy visit
$40 copay
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Physical therapy and speech and language therapy visit
$40 copay
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Additional Coverage Icon

Skilled Nursing Facility

Service
$0 per day for days 1 through 20 $203 per day for days 21 through 55 $0 per day for days 56 through 100
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Additional Coverage Icon

Transportation

Service
Not covered
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Vision

Routine eye exam
$0 copay
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Other
$0 copay
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Contact lenses
$0 copay
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Eyeglasses (frames and lenses)
$0 copay
Limit Icon
Eyeglass frames
Not covered
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Eyeglass lenses
Not covered
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Upgrades
$0 copay
Limit Icon
Additional Coverage Icon

Wellness programs (eg, fitness, nursing hotline)

Service
Covered
Overview Icon

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week

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Every year, Medicare evaluates plans based on a 5-star rating system.

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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.

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