Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H1994-016-000

Select Health Medicare NoRx (HMO) · Select Health · Davis, Salt Lake, Utah, and Weber Counties

Compact plan code: H1994016000

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Select Health Medicare NoRx (HMO)

H1994-016-000 Davis, Salt Lake, Utah, and Weber Counties HMO
Open in quick lookup
01

In-network

Inpatient hospital

Days 1–5 $500 / day
Days 6–90 $0 / day
Total of listed copays · 5 charged days $2,500
02

Emergency transport

Ambulance

Ground · in-network$250 copay
Air · in-network$250 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$6,700
Combined in + outNot reported
05

Skilled care at home

Home health

In-networkNo cost share reported
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + DNot reported

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H1994-001-000 Select Health Medicare Essential (HMO) Northern Utah · HMO H1994-012-000 Select Health Medicare Essential (HMO) Clark, Nye · HMO H1994-015-000 Select Health Medicare Dual (HMO D-SNP) Davis, Iron, Salt Lake, Utah, Washington, Weber · HMO H1994-017-000 Select Health Medicare Essential (HMO) Iron, Piute, Sanpete, Sevier, Wayne, Washington · HMO H1994-021-000 Select Health Medicare + Kroger (HMO) Clark and Nye · HMO H1994-022-000 Select Health Medicare + Kroger (HMO) Northern, Southwest, and Central Utah · HMO H1994-027-000 Select Health Medicare Essential (HMO) Colorado Front Range · HMO H1994-029-000 Select Health Medicare Essential (HMO) Delta and Mesa Counties · HMO

About this code

What H1994-016-000 identifies

H1994-016-000 is a Contract Year 2026 Medicare plan segment code. The compact form H1994016000 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.