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SCAN Balance (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Balance (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Balance (HMO C-SNP) in 2026, please refer to our full plan details page.
SCAN Balance (HMO C-SNP) is a HMO C-SNP 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 4 out of 5 stars in 2026.
It's important to know that SCAN Balance (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
SCAN Balance (HMO C-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 Balance (HMO C-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 Balance (HMO C-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 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 Balance (HMO C-SNP) plan offers a $0 drug deductible, allowing your prescription drug coverage to start right away. For Tier 1 preferred generics and Tier 2 generics, there is no copay for any supply length when filled through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options are also available, with copays starting at $5 for Tier 1 and $9 for Tier 2 generic drugs. For Tier 3 preferred brand drugs, copays start at $42 at preferred pharmacies and $47 at standard pharmacies for a 1-month supply. Tier 4 non-preferred medications require a 35% coinsurance regardless of the pharmacy or supply duration you choose. Specialty medications in Tier 5 carry a 33% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for inpatient hospital stays, primary care, specialist visits, and home health services. Outpatient hospital services, preventive care, and urgently needed services also feature no copay, while emergency room visits carry a $90 copay that is waived if you are immediately admitted. For specialized care, skilled nursing facility stays require no copay for the first 20 days, followed by a $125 daily copay for days 21 through 100. This plan also features valuable supplemental benefits, including preventive and comprehensive dental care up to a $3,000 annual maximum and routine vision exams with up to $300 annually for eyewear, both with no copay or coinsurance. Additionally, members receive up to 60 one-way transportation trips per year to plan-approved locations and routine hearing exams with no copay. Other cost-effective benefits include over-the-counter items and meals with no copay, as well as acupuncture for a $10 copay.
Inpatient Hospital See details
Inpatient hospital care is covered by SCAN Balance (HMO C-SNP), offering unlimited acute care stays with no copay and no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Psychiatric hospital stays are also covered with no coinsurance, requiring a $200 daily copay for days 1 through 7 and no copay for days 8 through 90.
Outpatient Services See details
Outpatient services are covered under the SCAN Balance (HMO C-SNP) plan, offering no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. Outpatient substance abuse services are also covered with no coinsurance, though individual and group sessions carry a $20 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the SCAN Balance (HMO C-SNP) plan with a $55.00 copay and no coinsurance. Accessing these services requires prior authorization and a referral.
Ambulance and Transportation Services See details
SCAN Balance (HMO C-SNP) covers ground and air ambulance services with a $125 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Balance (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, which is waived if you are immediately admitted to the hospital. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency services require no coinsurance with a $90 copay for emergency care and a $125 copay for emergency transportation.
Primary Care See details
SCAN Balance (HMO C-SNP) covers primary care, specialist, therapy, and telehealth services with no copay and no coinsurance, though podiatry is not covered. Chiropractic care is partially covered, excluding other chiropractic services, with a $10 copay and no coinsurance for up to 20 routine visits per year. Mental health, psychiatric, and opioid treatments are also covered with no coinsurance and copays ranging up to $20.
Preventive Services See details
SCAN Balance (HMO C-SNP) covers preventive services with no copay and no coinsurance, although prior authorization or referrals are required for some services. Additional preventive services are partially covered, with exclusions including medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Balance (HMO C-SNP), featuring one annual routine hearing exam and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to two per year with a $350 to $650 copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by SCAN Balance (HMO C-SNP) with no copay, no coinsurance, and no deductible, offering one routine eye exam and up to $300 annually for contacts or eyeglasses. Other eye exam services and eyewear upgrades are not covered, and prior authorization and referrals are required.
Dental Services See details
SCAN Balance (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive procedures, up to a $3,000 annual maximum. While services such as cleanings, exams, and restorative care are covered, orthodontics, other diagnostic dental services, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SCAN Balance (HMO C-SNP) with no copay, with prior authorization required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the SCAN Balance (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Medical Equipment See details
Medical Equipment is partially covered by SCAN Balance (HMO C-SNP), offering durable medical equipment, prosthetics, and medical supplies with no copay and 0% to 20% coinsurance. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by SCAN Balance (HMO C-SNP) with no copay and no coinsurance, although referrals and prior authorization are required. While some services are covered, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
SCAN Balance (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
SCAN Balance (HMO C-SNP) indicates some services are covered for Cardiac Rehabilitation Services with no copay and no coinsurance, although prior authorization and referrals are required. However, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
SCAN Balance (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a referral and prior authorization, and does not require a prior three-day hospital stay. There is no copay for days 1 through 20, a $125 copay per day for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SCAN Balance (HMO C-SNP) offers partially covered other services, which include acupuncture for a $10 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services and other miscellaneous services are not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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