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SCAN MyChoice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN MyChoice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN MyChoice (HMO) in 2025, please refer to our full plan details page.
SCAN MyChoice (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Clark County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that SCAN MyChoice (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 MyChoice (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 MyChoice (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 MyChoice (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic drugs. For standard generic drugs, the copay is $42.00-$43.00, depending on the pharmacy. For preferred brand drugs and non-preferred drugs, you will pay 50% and 33% coinsurance, respectively.
Additional Benefits
The SCAN MyChoice (HMO) plan offers a wide range of benefits with varying costs. You can expect no copays for many services including primary care, preventive services, home health, and diagnostic and radiological services. The plan covers inpatient and outpatient services, including substance abuse, with copays ranging from $0 to $20. Additional benefits include hearing, vision, and dental services, with copays and coverage limits for hearing aids, eyewear, and dental procedures.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital Psychiatric, you will pay a $200 copay for days 1-7, and no copay for days 8-90. Additional days and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric 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 between $20.00 and $20.00, and outpatient blood services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN MyChoice (HMO) with a $55 copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
The SCAN MyChoice (HMO) plan covers ambulance services with a $125 copay for both ground and air ambulance services, and no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $125 copay; Urgently Needed Services has no copay.
Primary Care See details
The SCAN MyChoice (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, 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
The SCAN MyChoice (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional services include health education, in-home support services, support for caregivers, fitness benefits, remote access technologies, and other preventive services, such as glaucoma screening and diabetes self-management training. Some preventive services are not covered, including in-home safety assessments, personal emergency response systems, and several more.
Hearing Services See details
Hearing Services for SCAN MyChoice (HMO) includes coverage for hearing exams and fitting/evaluation for hearing aids, with no deductible. Routine hearing exams are covered once per year and prescription hearing aids (all types) are covered up to two per year, with a copay between $550 and $850. Prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The SCAN MyChoice (HMO) plan covers vision services including routine eye exams with no copay, and eyewear with a combined maximum benefit of $300 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, while upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers dental services including 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), maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. Orthodontic services have a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the SCAN MyChoice (HMO) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies, is covered. DME has a coinsurance of 0% to 20%, and Prosthetic Devices have a coinsurance of 0% to 20%; however, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but some services are not 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 by SCAN MyChoice (HMO), with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $125.
Other Services See details
Under the SCAN MyChoice (HMO) plan, acupuncture has a $15 copay, and over-the-counter (OTC) items are covered up to $80 every three months. The plan also offers a meal benefit, and some other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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