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SCAN Connections (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Connections (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Connections (HMO D-SNP) in 2026, please refer to our full plan details page.
SCAN Connections (HMO D-SNP) is a HMO D-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in Los Angeles, Inland Empire, and San Diego Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that SCAN Connections (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
SCAN Connections (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about SCAN Connections (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For SCAN Connections (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $375.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The SCAN Connections (HMO D-SNP) prescription plan features a $375.00 drug deductible before your initial coverage phase begins. During this initial phase, Tier 1 preferred generic drugs have no copay at preferred pharmacies and preferred mail-order services, or a $1.00 copay at standard pharmacies and standard mail. Other tiers require coinsurance, including 25% for Tier 2 standard generics and Tier 4 non-preferred drugs, and 29% for Tier 3 preferred brand drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, members who qualify for the full low-income subsidy (LIS) will benefit from a premium reduction and pay nothing for Part D coverage. This Enhanced Alternative plan is designed to help you manage and lower your annual medication expenses.
Additional Benefits
The SCAN Connections (HMO D-SNP) plan offers comprehensive medical coverage featuring no copay and a 20% coinsurance for most primary care, specialist, outpatient, and emergency services. Inpatient hospital and skilled nursing facility stays follow Original Medicare cost-sharing guidelines, while annual physicals and key preventive services require no copay or coinsurance. Many of these primary medical benefits require prior authorization and a doctor referral to be covered. Additional benefits include routine dental care with no copay or coinsurance, along with routine vision and hearing exams featuring no copay and up to 20% coinsurance. Members can also access unlimited rides to plan-approved health locations, a 115 dollar monthly over-the-counter allowance, and up to 36 acupuncture visits with no copays or coinsurance. Note that some services, such as cardiac rehabilitation and orthodontics, are not covered under this plan.
Inpatient Hospital See details
SCAN Connections (HMO D-SNP) partially covers inpatient hospital services, requiring prior authorization and a doctor referral for acute and psychiatric stays. Copay and coinsurance costs follow Original Medicare-defined cost sharing, while upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the SCAN Connections (HMO D-SNP) plan are covered with no copay and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization and a doctor referral are required for these covered benefits.
Partial Hospitalization See details
SCAN Connections (HMO D-SNP) covers partial hospitalization benefits with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under SCAN Connections (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency and urgently needed services, including worldwide emergency coverage and transportation, are covered under SCAN Connections (HMO D-SNP) with a 20% coinsurance and no copay. A maximum per-visit cost of $115 applies to emergency services and $40 to urgent care, both of which count toward the plan-level deductible.
Primary Care See details
Primary Care benefits are partially covered under the SCAN Connections (HMO D-SNP) plan, as podiatry services are not covered. Most covered services, including primary care physician, specialist, and therapy visits, require a 20% coinsurance and no copay, with most also requiring prior authorization and a doctor referral.
Preventive Services See details
Preventive Services are partially covered under SCAN Connections (HMO D-SNP), featuring no copay or coinsurance for annual physical exams and Medicare-covered zero-dollar preventive services. Kidney disease education and other preventive screenings require a 20% coinsurance and no copay, while uncovered services include medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation sessions, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Connections (HMO D-SNP), which provides one annual routine hearing exam with no copay and up to 20% coinsurance. The plan also covers up to two annual prescription hearing aids with a $699 to $999 copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
SCAN Connections (HMO D-SNP) covers one routine eye exam annually with no copay and a 20% coinsurance. Eyewear is partially covered with no copay and a 20% coinsurance up to a $500 annual limit, though eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by SCAN Connections (HMO D-SNP), with orthodontics being the only service not covered. Medicare-covered dental services require a 20% coinsurance and no copay, while other preventive and comprehensive dental services are covered with no copay and no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN Connections (HMO D-SNP) with prior authorization, featuring no copay and 0% to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, which counts toward the plan's deductible.
Dialysis Services See details
SCAN Connections (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
Medical equipment is covered by SCAN Connections (HMO D-SNP) with no copay and a 20% coinsurance. Covered items include durable medical equipment, prosthetic devices, and diabetic supplies, all of which require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by SCAN Connections (HMO D-SNP) with no copay and a 20% coinsurance, though lab services are not covered. Covered services, which include diagnostic procedures, radiological services, and outpatient X-rays, require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by SCAN Connections (HMO D-SNP), requiring prior authorization and a doctor referral. Specific copay and coinsurance details are not specified for this covered benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under SCAN Connections (HMO D-SNP), which includes cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Connections (HMO D-SNP), with cost sharing determined by Medicare-defined copays and coinsurance. Prior authorization and a doctor referral are required, and while a three-day prior hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under SCAN Connections (HMO D-SNP), which excludes Dual Eligible SNPs with Highly Integrated Services. Covered options include up to 36 acupuncture visits per year, a $115 monthly over-the-counter allowance, and post-hospitalization meal benefits, all provided with no copays or coinsurance.
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