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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 2026, 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 4 out of 5 stars in 2026.
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 $1400.00 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) prescription drug benefit features a $0 drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for one, two, or three-month supplies at all preferred, standard, and mail-order pharmacies. This plan offers exceptional value for those seeking to minimize their daily medication costs. For Tier 3 preferred brand drugs, copays start at $42 for a one-month supply at preferred locations and mail-order services, and $43 at standard pharmacies. Tier 4 non-preferred drugs require a 35% coinsurance, while Tier 5 specialty drugs incur a 33% coinsurance for a one-month supply. These clear pricing tiers allow you to easily project your annual out-of-pocket healthcare expenses.
Additional Benefits
The SCAN MyChoice (HMO) plan offers comprehensive coverage with no copay and no coinsurance for primary care, specialist visits, preventive services, and outpatient hospital care. For inpatient hospital stays, members pay a low daily copay of $50 for days 1 through 5, while skilled nursing facility stays feature no copay for the first 20 days. Emergency room visits require a $90 copay, which is waived if admitted, and urgent care services are available with no copay. This plan also features robust supplemental coverage, including dental, vision, and hearing services with no copay for routine exams. Vision benefits include a $235 eyewear allowance every three months, and hearing aid coverage is available with copays ranging from $550 to $850 per device. Additionally, most durable medical equipment and dialysis services carry no copay with coinsurance up to 20 percent, ensuring affordable access to essential care.
Inpatient Hospital See details
SCAN MyChoice (HMO) covers inpatient hospital services with no coinsurance, requiring a $50 daily copay for days 1 to 5 of acute stays and a $200 daily copay for days 1 to 7 of psychiatric stays, with no copay for subsequent days. Prior authorization and referrals are required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN MyChoice (HMO) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. Outpatient substance abuse services are also covered with no coinsurance, but require a $20 copay for individual and group sessions.
Partial Hospitalization See details
SCAN MyChoice (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services through SCAN MyChoice (HMO) feature a $125 copay and no coinsurance for Medicare-covered ground and air ambulance services, which require prior authorization. While transportation services are technically covered, trips to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by SCAN MyChoice (HMO) with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services have no copay or coinsurance, and worldwide emergency services are covered with no coinsurance, a $90 copay for emergency care, and a $125 copay for emergency transportation.
Primary Care See details
Primary care benefits under SCAN MyChoice (HMO) are partially covered, offering no copay and no coinsurance for primary care, specialist, therapy, and telehealth services, while podiatry and other chiropractic services are not covered. Routine chiropractic care requires a $15 copay, opioid treatment has a $20 copay, and mental health or psychiatric sessions range from no copay to a $20 copay, all with no coinsurance.
Preventive Services See details
SCAN MyChoice (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and Medicare-covered screenings. Additional preventive benefits are partially covered, offering health education, caregiver support, memory fitness, and remote access, while services such as in-home safety assessments, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), offering no copay or coinsurance for one annual routine hearing exam and unlimited fitting evaluations. Prescription hearing aids are covered for up to two devices per year with no coinsurance and a copay ranging from $550 to $850, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
SCAN MyChoice (HMO) offers partially covered vision services with no copay, no coinsurance, and no deductible for one routine eye exam per year and contact lenses or eyeglasses with a $235 allowance every three months. Other eye exam services and eyewear upgrades are not covered, and prior authorization and referrals are required.
Dental Services See details
Dental services are partially covered by SCAN MyChoice (HMO) with no copay and no coinsurance for covered services, although prior authorization is required for some treatments. While preventive and restorative care are included, other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN MyChoice (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay with coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by SCAN MyChoice (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Medical equipment is partially covered by SCAN MyChoice (HMO) with no copay and prior authorization required for most items, though diabetic supplies are not covered. Covered durable medical equipment, prosthetics, and medical supplies carry no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
SCAN MyChoice (HMO) covers diagnostic and radiological services with no copay and no coinsurance, but in practice, these services are not covered because diagnostic procedures, lab services, radiological services, and outpatient X-rays are excluded.
Home Health Services See details
Home health services are covered by SCAN MyChoice (HMO) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
SCAN MyChoice (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, requiring prior authorization and a referral. While some services are covered under this benefit, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $125 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered by SCAN MyChoice (HMO) include acupuncture for a $15 copay and no coinsurance, up to 30 treatments per year with prior authorization. Members also have access to over-the-counter items and limited-duration meal benefits, both offered with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
* 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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