SelectHealth Medicare Part C Review: HMO and Special Needs Plans Across Utah and Nevada.
Key Takeaways
SelectHealth offers comprehensive Medicare Advantage coverage across four Mountain West states with unique benefits that set it apart from traditional insurers.
• SelectHealth operates as a not-for-profit insurer serving 900,000+ members across Utah, Idaho, Nevada, and Colorado with $0 premium plans
• Regional pricing varies significantly – Henderson, Nevada, offers the lowest costs with a $900 max out-of-pocket, while Idaho Falls has the highest at $6,750
• Special Needs Plans target chronic conditions like heart disease, lung disorders, and diabetes with coordinated care through the Intermountain Healthcare partnership
• HMO structure requires in-network providers but includes valuable extras like $240 annual wellness rewards, $50 quarterly OTC allowances, and Silver&Fit gym membership
• The integrated healthcare model combines insurance with clinical services, providing coordinated care that traditional insurers cannot match
SelectHealth’s partnership with Intermountain Healthcare creates a unique value proposition for Medicare beneficiaries who prioritize coordinated care and don’t mind network restrictions. The significant regional cost differences make location a crucial factor in plan selection.
SelectHealth stands out as a not-for-profit Medicare Advantage provider. The company serves more than 900,000 members in Utah, Idaho, Nevada, and Colorado.
Their focus on chronic condition management caught my attention while researching SelectHealth HMO and Special Needs Plans. They specifically target heart and lung conditions, as well as diabetes.
Their partnership with Intermountain Healthcare adds integrated care that sets them apart from traditional insurance models.
This review breaks down SelectHealth Advantage plans and compares pricing across regions. We’ll walk through everything you need to make an informed decision about coverage.
SelectHealth Medicare Overview: Not-for-Profit Health Insurance
What Makes SelectHealth Different
SelectHealth has operated as a not-for-profit health plan since 1983 and takes a different approach to insurance than most carriers I’ve reviewed [1][2]. The company doesn’t answer to shareholders looking for quarterly profits. Every dollar goes back into member benefits, provider networks, and community health initiatives instead.
This structure allows SelectHealth to focus on long-term health outcomes rather than short-term financial gains. The company dedicates resources to community relations efforts that reached 1.5 million people through more than 600 touchpoints in 2025. They partnered with 224 community organizations focused on healthcare access and wellness resources [1].
SelectHealth Medicare Advantage plans combine medical and pharmacy benefits into a single package [1]. This integration eliminates the need to juggle separate Medicare Part D prescription coverage. The company doesn’t offer standalone Part D plans, so all prescription drug coverage is bundled into its Advantage offerings [1].
Their commitment to simplifying what’s typically a confusing process struck me during my research. SelectHealth built its entire operational model around making “insurance simple” by cutting through complex processes, unclear costs, and confusing language that plague traditional insurance [1].
Members access telehealth services through Intermountain Healthcare’s ConnectCare program and can schedule appointments via computer or smartphone [1]. This digital access point became especially valuable during routine consultations and follow-up visits.
Service Areas and Member Base
SelectHealth serves more than 1.1 million members across Utah, Idaho, Nevada, and Colorado [1][3]. The geographic footprint spans the Mountain West region. The company maintains deep roots in each state’s healthcare landscape.
The member base has diverse populations: individuals, families, employers, Medicaid beneficiaries, and federal employee benefits recipients [4]. Utah and Idaho formed the original service territories. Nevada was added as the company expanded its regional presence.
Colorado represents the newest market. SelectHealth launched Medicare Advantage plans and individual and family health insurance on the state exchange effective January 1, 2024 [2]. This expansion came through a strategic collaboration with UCHealth that began in early 2023.
SelectHealth maintains a network of more than 23,000 providers across these four states [3]. The provider network has doctors, hospitals, specialists, and affiliated clinics that keep care close to home for members.
Partnership with Intermountain Healthcare
SelectHealth operates as a wholly owned subsidiary of Intermountain Health and creates an integrated care model that connects insurance with clinical services [1][2]. This relationship sets SelectHealth apart from traditional insurance carriers that process claims without direct involvement in healthcare delivery.
The integration with Intermountain Health strengthens access to best-in-class clinical services across all markets [1]. Members benefit from coordinated care between their insurance coverage and the healthcare systems providing treatment.
SelectHealth deepened this model through partnerships with UCHealth in Colorado. The collaboration brought UCHealth Plan Administrators into the SelectHealth umbrella and created Simplified Benefits Administrators to serve self-funded employers [2]. This partnership will give alignment between a large regional health plan and local healthcare delivery systems.
SelectHealth members access care through established relationships with major health systems rather than fragmented provider networks. The company commits to value-based care, which ties provider compensation to patient outcomes rather than volume of services [1].
Rob Hitchcock, SelectHealth’s president and CEO, emphasized that the mission guides every decision and prioritizes real needs like food security, housing stability, preventive care, and healthcare access [1]. These social determinants of health receive sponsorship focus alongside traditional medical coverage [3].
Understanding SelectHealth HMO and Special Needs Plans
Health Maintenance Organization (HMO) Structure
SelectHealth HMO plans require members to receive healthcare exclusively from doctors and facilities within the plan’s network, with exceptions for emergency care, out-of-area urgent care, or temporary dialysis needs [1]. The network has contracted doctors, hospitals, and medical facilities that agree to provide services under specific terms.
Most SelectHealth HMO plans require a primary care physician to be selected, though specialist referrals vary by plan design [1]. The trade-off for network restrictions is lower out-of-pocket expenses compared to other plan types. This structure emphasizes preventive care and coordinated treatment through your primary doctor.
How In-Network Providers Work
In-network providers keep costs down substantially. You’ll pay higher rates and might receive balance bills for the difference between what the provider charges and what the plan pays when you visit an out-of-network provider [1].
SelectHealth’s provider network has more than 23,000 doctors and facilities in Utah, Idaho, Nevada, and Colorado. Members can search the online directory at selecthealth.org/findadoctor or call Member Services at 800-538-5038 to find in-network providers [5].
Be aware that in-network providers sometimes use out-of-network services for lab work or other ancillary care. Check with your provider before receiving services to prevent surprise bills.
Special Needs Plans for Chronic Conditions
Special Needs Plans provide tailored benefits for people with specific diseases, certain healthcare needs, or those with both Medicare and Medicaid coverage [1]. SNPs customize their benefits, provider choices, and drug coverage to meet the specific needs of the populations they serve.
SelectHealth offers Dual Eligible SNPs (D-SNP) in some states if you qualify for both Medicare and Medicaid [1]. These plans coordinate benefits between both programs and eliminate gaps in coverage.
SNPs follow either HMO or PPO structures and cover standard Medicare Part A and Part B services. They often have extra services tailored to their target populations. SNPs may cover additional days beyond standard Medicare limits for hospital stays related to severe or chronic conditions like cancer or chronic heart failure [1].
Heart Care Plan Benefits
SelectHealth covers chronic heart failure as a qualifying condition for Special Needs Plans [6]. The heart care benefits extend to members with heart failure diagnoses and those with hypertensive heart disease and chronic kidney disease [6].
These plans coordinate cardiovascular care and ensure that specialized delivery systems address the complex needs of heart patients.
Lung Care Plan Benefits
Chronic lung disorders qualify for SelectHealth Special Needs Plans and are covered by these plans, including asthma, chronic bronchitis, emphysema, pulmonary fibrosis, and pulmonary hypertension [7]. These conditions require ongoing management and coordination with multiple healthcare providers.
The specialized benefits focus on respiratory care management and ensure members have access to appropriate specialists and treatments for their specific lung conditions.
Diabetes Care Plan Benefits
Diabetes mellitus qualifies as both a standalone chronic condition for SNP enrollment and a component of comorbid condition groupings [7]. SelectHealth accepts members with diabetes alone or in combination with chronic heart failure and cardiovascular disorders.
The diabetes-focused benefits coordinate care between primary physicians, endocrinologists, nutritionists, and other specialists who manage blood sugar control and prevent complications.
SelectHealth Advantage Plans: Complete Coverage Breakdown
Medicare Part A and Part B Coverage
SelectHealth Advantage plans provide all coverage mandated by Medicare Parts A and B [1]. Part A handles hospital insurance and covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Part B covers medical insurance that has doctor visits, outpatient care, preventive services, and durable medical equipment.
Parts A and B merge into a single plan, simplifying administration. You’ll pay your Medicare Part B premium to the government, then any additional premium charged by SelectHealth on top of that [1]. The Medicare Essential plan offers a $0 monthly premium. You pay only your standard Part B premium, without additional charges [8].
Prescription Drug Coverage Details
SelectHealth Advantage plans combine medical and pharmacy benefits into a single package [1][9]. This bundled approach removes the need to enroll in a standalone Medicare Part D plan for prescription coverage. SelectHealth doesn’t offer separate Part D plans, so all drug coverage is integrated into its Advantage offerings.
Zero-Cost Preventive Services
Most SelectHealth plans cover preventive care at 100% with no copay, coinsurance, or deductible required [10]. This has physicals, mammograms, flu shots, and other screenings. Your doctor must bill claims using preventive codes for services to qualify for zero-cost coverage [10][2].
When a preventive service identifies a condition that requires further testing or treatment, you’ll pay regular cost-sharing amounts [2]. Preventive services are covered once every 12 months [2]. Call Member Services at 800-538-5038 on weekdays from 7:00 a.m. to 8:00 p.m. and on Saturdays from 9:00 a.m. to 2:00 p.m. to verify whether a specific service qualifies as preventive [2].
Gym Membership and Wellness Allowances
SelectHealth Medicare Essential plans have Silver&Fit membership and provide access to the Healthy Aging and Exercise program [8]. Eligible members can earn up to $240 per person through wellness rewards each year [3]. This benefit reimburses gym membership costs when you track activities through your member account.
Over-the-Counter Medication Allowances
The Medicare Essential plan provides a $50 quarterly allowance for over-the-counter items such as pain relievers, vitamins, bandages, and first-aid supplies [8]. You must use your full benefit amount for a single order. Unused benefits don’t carry over to the next quarter [11]. Orders ship to your door, and you cannot purchase OTC items at retail pharmacies for reimbursement [11].
Transportation to Medical Appointments
Some SelectHealth Medicare plans offer non-emergency medical transportation benefits for trips to doctor appointments and pharmacies [12]. Check your Evidence of Coverage to determine if your specific plan has this benefit.
SelectHealth Pricing and Plan Tiers Across Four States
SelectHealth Medicare Essential Plan Costs
SelectHealth Medicare Essential is the flagship HMO offering across all four service states. The plan carries a $0 monthly premium [8]. You pay only your standard Medicare Part B premium, with no additional charges. Medical deductibles sit at $0 for most regions [8][1], though drug deductibles vary by location and create different cost-sharing scenarios depending on where you live.
Primary care visits cost nothing in Utah locations like Salt Lake City and Cache County [1]. Emergency room copays run $95 per visit [13], while urgent care visits require a $35 copay [13]. Inpatient hospital stays charge $410 per day for the first five days and then drop to $0 for days six through ninety [13].
Premium-Free Plan Options
SelectHealth Advantage plans maintain the $0 monthly premium structure in Utah, Idaho, Nevada, and Colorado markets [1]. This pricing model applies to the Medicare Essential HMO product and allows members to access comprehensive coverage without premium costs beyond their Part B obligation. The plan has $1,000 in dental coverage for checkups, fillings, and crowns with no waiting period [8].
Regional Price Variations
Specialist visit copays demonstrate the most important regional differences. Members in Salt Lake City and Cache County pay $15 for specialist visits [1]. Idaho Falls residents face $30 specialist copays [1], while Boulder, Colorado members pay $25 [1]. Henderson, Nevada, stands out for having $0 specialist copays [1] and offers the lowest cost-sharing structure among all markets.
Comparing Deductibles by Location
Drug deductibles shift by state. Utah locations carry a $200 annual prescription deductible [1]. Idaho Falls matches this $200 drug deductible [1]. Henderson, Nevada, and Boulder, Colorado, feature $0 drug deductibles [1] and eliminate upfront prescription costs before coverage begins [1].
Maximum Out-of-Pocket Expenses
The in-network maximum out-of-pocket limit ranges from $900 to $6,750, depending on your location [1]. Henderson, Nevada, offers the lowest MOOP at $900 annually [1] and provides exceptional financial protection. Boulder, Colorado, members face a $3,900 MOOP [1]. Salt Lake City and Cache County maintain a $4,900 limit [1]. Idaho Falls carries the highest MOOP at $6,750 [1], though this still falls below the 2023 measure of $6,700 seen in earlier plan years [13].
How to Choose and Enroll in SelectHealth Plans
Eligibility Requirements for Medicare Advantage
You must enroll in both Medicare Part A and Part B to qualify for SelectHealth Medicare Advantage. You also need to live within SelectHealth’s service area in Utah, Idaho, Nevada, or Colorado. Most people become eligible at age 65, though certain disabilities or conditions, such as End-Stage Renal Disease, allow younger people to qualify.
Finding SelectHealth Providers in Your Area
Choosing a primary care doctor is the first step in your healthcare experience with SelectHealth. The provider search tool at selecthealth.org makes it easy to find doctors near home who fit your schedule [6]. Primary care focuses on preventive visits, immunizations, and screenings. It also coordinates specialist referrals when needed [6].
Urgent care centers provide treatment without appointments for urgent, non-life-threatening issues, such as minor injuries or flu symptoms [6]. Emergencies that involve chest pain, severe bleeding, or breathing trouble demand ER visits right away [6].
Comparing Plans by ZIP Code
SelectHealth plans vary substantially by location. Different copays, deductibles, and maximum out-of-pocket limits depend on your ZIP code. Browse plans online at selecthealth.org/medicare or call 855-442-9940 to get customized assistance comparing options in your area [7].
When You Can Enroll or Switch Plans
The Annual Enrollment Period runs from October 15 through December 7 each year [7]. You can review your current plan and make changes to your plan for the upcoming year during this window.
SelectHealth’s 5-Star rating opens an additional Special Enrollment Period from December 8 through November 30. This allows switches from lower-rated plans [7].
What Happens If You Move Outside Service Area
A move outside SelectHealth’s service area triggers a Special Enrollment Period. Your SEP begins the month before you move and continues for two full months after if you notify Medicare before moving [14]. Notifying Medicare after your move starts the SEP right away and extends it by 2 additional months [14].
You’ll need to switch to a new Medicare Advantage plan in your new location or return to Original Medicare [14].
Conclusion
SelectHealth delivers solid value for Medicare Advantage seekers, especially in Las Vegas, Summerlin, Henderson, and North Las Vegas, where the $900 maximum out-of-pocket limit stands out among the four-state coverage area. The $0 premium structure makes it available, though regional pricing differences matter. Idaho Falls members face higher cost-sharing than their counterparts in Nevada.
The integrated Intermountain Healthcare partnership provides coordinated care that traditional insurers can’t match. The Special Needs Plans for heart and diabetes management demonstrate a real dedication to supporting people with chronic conditions. SelectHealth works best for those living near Intermountain provider networks who value preventive care and don’t mind HMO network restrictions, my research shows.
FAQs
Q1. Is SelectHealth Medicare Advantage a good insurance option? SelectHealth offers comprehensive Medicare Advantage plans with several valuable features, including $0 monthly premiums, integrated prescription drug coverage, no-cost preventive care, and wellness benefits such as gym memberships and over-the-counter medication allowances. The plans work particularly well for individuals with chronic conditions, thanks to their specialized Heart Care, Lung Care, and Diabetes Care programs. However, the value varies by location, with some regions offering significantly lower out-of-pocket maximums than others.
Q2. Does SelectHealth provide coverage when traveling outside your home state? Yes, SelectHealth covers urgent and emergency care even when you’re traveling outside your service area. Emergencies like chest pain or severe injuries are covered at any emergency room, and urgent care for non-life-threatening issues is also included when you’re away from home. However, for routine care, you’ll need to use in-network providers within SelectHealth’s service areas of Utah, Idaho, Nevada, and Colorado.
Q3. What is the relationship between SelectHealth and Intermountain Healthcare? SelectHealth operates as a wholly owned subsidiary of Intermountain Health, creating an integrated care model that connects insurance coverage with clinical services. This partnership provides members with coordinated care through a network of more than 23,000 providers and ensures alignment between insurance benefits and healthcare delivery. The integration allows for better care coordination and access to Intermountain Healthcare’s clinical services across all markets.
Q4. Does SelectHealth offer Medicaid coverage in Utah? Yes, SelectHealth administers Select Health Community Care, a managed Medicaid plan available to eligible Utah residents with limited incomes and resources who live within SelectHealth’s service area. Additionally, SelectHealth offers Dual-Eligible Special Needs Plans (D-SNPs) in some states for individuals who qualify for both Medicare and Medicaid, coordinating benefits between the two programs.
Q5. How do I find doctors and healthcare providers who accept SelectHealth? You can locate SelectHealth providers by using the online search tool at selecthealth.org/findadoctor or by calling Member Services at 800-538-5038. The network includes more than 23,000 doctors, hospitals, and medical facilities across Utah, Idaho, Nevada, and Colorado. Most SelectHealth HMO plans require you to select a primary care physician and use in-network providers to keep costs down, though emergency care is covered anywhere.
References
[1] – https://www.healthline.com/health/medicare/select-health-medicare-advantage
[2] – https://selecthealth.org/blog/health-insurance-basics/stay-healthy-with-preventive-care
[3] – https://selecthealth.org/wellness/wellness-rewards
[4] – https://www.medicalnewstoday.com/articles/select-health-medicare-advantage
[5] – https://selecthealth.org/files/sbc/I40A2103_20250101_GGGGGGGG_GGGG_SSSS.pdf
[6] – https://selecthealth.org/resources/plan-resources
[7] – https://selecthealth.org/blog/medicare/understanding-the-basics-of-medicare-advantage
[8] – https://selecthealth.org/medicare/ma-plans-utah
[9] – https://selecthealth.org/medicare/pharmacy/resources/pharmacy-benefits
[10] – https://selecthealth.org/content/dam/selecthealth/General/PDFs/preventive-care-services-flyer.pdf
[11] – https://files.selecthealth.cloud/api/public/content/238048-2022_HMO_OTC_Guide.pdf
[12] – https://selecthealth.org/medicare/benefits/transportation
[13] – https://www.factsonmedicare.com/medicare-advantage/selecthealth-medicare-essential-hmo-h1994-001-0/
[14] – https://triagehealth.org/quick-guides/healthinsurancewhenmoving/
