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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 2025, 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. The overall rating for this plan is not yet available for 2025.
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 $6.10. 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 $590.00 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 $9350.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, and a $1.00 copay at standard pharmacies and standard mail order. After your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The SCAN Connections (HMO D-SNP) plan offers a wide array of benefits, including coverage for inpatient and outpatient services, with a 20% coinsurance for many services. Emergency, urgent, and worldwide emergency services have no copay. Additionally, the plan covers hearing and vision services with 20% coinsurance, and dental services with copays ranging from $0 to $350. This plan also includes coverage for ambulance and transportation services with a 20% coinsurance, as well as a range of preventive services. Other notable benefits include coverage for home health services with no copay or coinsurance, medical equipment with a 20% coinsurance, and a monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. However, additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, non-Medicare-covered stays for both, and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered by SCAN Connections (HMO D-SNP), with the following cost sharing: Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center Services and Outpatient Substance Abuse Services each have a 20% coinsurance for covered services like individual and group sessions. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN Connections (HMO D-SNP), but requires prior authorization and a doctor referral. This plan has a 20% coinsurance for partial hospitalization services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Connections (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered, with a 20% coinsurance. There is no copay for these services.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with 20% coinsurance, Chiropractic Services with 20% coinsurance, Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with 20% coinsurance, and Mental Health Specialty Services with 20% coinsurance. Additionally, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with 20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
Preventive services are covered, including annual physical exams, health education, in-home safety assessments, personal emergency response systems, in-home support services, support for caregivers of enrollees, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance. Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a coinsurance of at most 20% and routine hearing exams once per year, as well as Fitting/Evaluation for Hearing Aid. Prescription Hearing Aids (all types) are covered with a copay between $699 and $999 for 2 visits every year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear, with a 20% coinsurance. Eyewear has a combined maximum benefit of $500 per year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with 20% coinsurance for Medicare Dental Services. Other dental services include oral exams, dental x-rays (2 per year), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), other preventive dental services, and restorative services, which have a copay between $0 and $350, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery, which have a copay between $0 and $350, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0% and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Connections (HMO D-SNP) plan and require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is covered with coinsurance and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Connections (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the SCAN Connections (HMO D-SNP) plan. Prior authorization and a doctor referral are required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered days for SNF, and also does not cover non-Medicare-covered stays for SNF.
Other Services See details
Other Services offered by the SCAN Connections (HMO D-SNP) plan include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered with a limit of 36 treatments per year, and prior authorization is required. OTC items are covered up to $65.00 per month, including nicotine replacement therapy and Naloxone. The meal benefit is available following surgery or inpatient hospitalization, for chronic illness, or for a medical condition that requires the enrollee to remain at home for a period of time. Some other services, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services, are not covered.
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