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SCAN Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Classic (HMO) in 2025, please refer to our full plan details page.
SCAN Classic (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that SCAN Classic (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about SCAN Classic (HMO).
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 Classic (HMO), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $900.00 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 Classic (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance based on the drug tier and pharmacy type. Preferred generic drugs have no copay at preferred pharmacies and preferred mail order, but cost $9 at standard pharmacies. For standard generic drugs, the copay is $42 at preferred pharmacies and preferred mail order, and $47 at standard pharmacies. Preferred brand drugs and non-preferred drugs have a 50% and 33% coinsurance, respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The SCAN Classic (HMO) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with specific copays for certain services like psychiatric care and substance abuse treatment. You'll find coverage for emergency services, primary care, preventive services, and hearing and vision services, with varying copays and annual limits. Dental care includes coverage for exams, X-rays, and other services. This plan provides additional benefits such as ambulance services, transportation to health-related locations, and home infusion services with copays or coinsurance. It also covers medical equipment, home health services, and skilled nursing facilities, with specific cost-sharing structures. Other covered services include acupuncture, over-the-counter items, and meal benefits, while some services like orthodontics and certain rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute care, are covered, with additional days covered as well. Inpatient Hospital Psychiatric has a $200 copay for days 1-7, and no copay for days 8-90, while non-Medicare-covered stays and upgrades for Inpatient Hospital are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Individual and group sessions for outpatient substance abuse have a copay of $20.00.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $55 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $125 copay. Transportation Services to a plan-approved health-related location are covered for up to 54 one-way trips per year, using rideshare services, bus/subway, or medical transport, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, and Worldwide Emergency Services are covered under the SCAN Classic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Worldwide Emergency Transportation has a $125 copay, and Urgently Needed Services has no copay.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $15 copay for routine care, and individual and group mental health and psychiatric sessions have a copay between $0 and $20.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and additional preventive services. Health education, personal emergency response systems, in-home support services, support for caregivers of enrollees, remote access technologies, and fitness benefits are covered. In-home safety assessments, 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 benefits, 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 are covered, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $550 and $850, and the plan covers 2 visits per year.
Vision Services See details
The SCAN Classic (HMO) plan covers vision services including eye exams and eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered once per year. Eyewear has a combined maximum benefit of $300 per year, and upgrades are not covered.
Dental Services See details
Dental services with the SCAN Classic (HMO) plan include coverage for oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 visits per year), restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. Fluoride treatment, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum plan benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by SCAN Classic (HMO), including Durable Medical Equipment with 0-20% coinsurance, Prosthetics/Medical Supplies with 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the SCAN Classic (HMO) plan, but no services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. There is no copay for these services.
Home Health Services See details
Home Health Services are covered under the SCAN Classic (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
The SCAN Classic (HMO) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $125 per day; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the SCAN Classic (HMO) plan, acupuncture is covered with a $15 copay, and up to 30 treatments are allowed per year, while over-the-counter items are covered up to $95 every three months, and meal benefits are also covered. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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