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Select Health Medicare Choice (PPO)

H2246 - 018 - 0
3.5 out of 5 stars (3.5 / 5)

select-health medicare provider logo

Select Health Medicare Choice (PPO) is a Medicare Advantage Plan by Select Health.

This page features plan details for 2025 Select Health Medicare Choice (PPO) H2246 – 018 – 0 available in Northern and Southwest Utah and Franklin County ID.

Locations

Select Health Medicare Choice (PPO) is offered in the following locations.

Box Elder County, Utah
Cache County, Utah
Davis County, Utah

Click to see more locations

Plan Overview

Select Health Medicare Choice (PPO) offers the following coverage and cost-sharing.

Insurer:Select Health
Health Plan Deductible:$0
MOOP:$9,550 In and Out-of-network
$5,700 In-network
Drugs Covered:Yes

Ready to sign up for Select Health Medicare Choice (PPO) ?

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

Premium Breakdown

Select Health Medicare Choice (PPO) has a monthly premium of $14.00. 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 $14.00 $ $
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 Choice (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $100.00
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
$14.00$0.70

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 $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 Choice (PPO) 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)
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 10% Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay (Authorization Required)
    • Out-of-Network: 10% Coins – No Copay (Authorization Required)
  • Oral Exams
    • In-Network: No Coins – No Copay (Authorization Required)
    • Out-of-Network: 10% Coins – No Copay (Authorization Required)
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Authorization Required)
    • Out-of-Network: 10% Coins – No Copay (Authorization Required)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Authorization Required)
    • Out-of-Network: 10% Coins – No Copay (Authorization Required)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay (Authorization Required)
    • Out-of-Network: 10% Coins – No Copay (Authorization Required)

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • In-Network: $0-15 copay or 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-200 copay (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: 30% coinsurance (Authorization Required)

Doctor visits

  • Primary
    • Out-of-Network: 30% coinsurance per visit
  • Specialist
    • Out-of-Network: 30% coinsurance per visit
  • Primary
    • In-Network: $0 copay
  • Specialist
    • In-Network: $15 copay per visit

Emergency care/Urgent care

  • Urgent care
    • $40 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $15 copay
  • Routine foot care
    • In-Network: $15 copay (Limits Apply)
  • Foot exams and treatment
    • Out-of-Network: 30% coinsurance

Ground ambulance

    • In-Network: $225 copay
    • Out-of-Network: $225 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids
    • Out-of-Network: $499-799 copay
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $15 copay
  • Fitting/evaluation
    • Out-of-Network: $0 copay (Limits Apply)
  • Hearing aids
    • In-Network: $699-999 copay
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 30% coinsurance

Inpatient hospital coverage

    • Out-of-Network: 30% per stay (Authorization Required)
    • In-Network: $420 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)

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

    • $9,550 In and Out-of-network
      $5,700 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 0-20% coinsurance per item (Authorization Required)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
    • Out-of-Network: 30% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)
  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit
    • Out-of-Network: 30% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $15 copay
  • Outpatient group therapy visit
    • Out-of-Network: 30% coinsurance
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 30% coinsurance
  • Outpatient individual therapy visit
    • In-Network: $15 copay
  • Inpatient hospital – psychiatric
    • Out-of-Network: 30% per stay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $15 copay
  • Inpatient hospital – psychiatric
    • In-Network: $370 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $15 copay
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 30% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $15-360 copay or 20% coinsurance per visit (Authorization Required)
    • Out-of-Network: 30% coinsurance per visit (Authorization Required)

Preventive care

    • Out-of-Network: $0 copay
    • In-Network: $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 30% coinsurance (Authorization Required)
    • In-Network: $30 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $30 copay (Authorization Required)
    • Out-of-Network: 30% coinsurance (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 55
      $0 per day for days 56 through 100 (Authorization Required)
    • Out-of-Network: 30% per stay (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • Not covered
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Out-of-Network: $0 copay (Limits Apply)
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • In-Network: $0 copay (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Out-of-Network: $0 copay (Limits Apply)

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

    • Covered

Ready to sign up for Select Health Medicare Choice (PPO) ?

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 Choice (PPO)? See 2025 Select Health Medicare Choice (PPO) at MedicareAdvantageRX.com.

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