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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 Maricopa, Pima and Pinal 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 $2800.00 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. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies. For preferred brand drugs and non-preferred drugs, you will pay 50% and 33% coinsurance, respectively. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The SCAN Classic (HMO) plan provides coverage for a range of services with varying costs. Inpatient hospital stays have copays, while outpatient services, including substance abuse treatment, have copays of $20. Emergency services have a $90 copay, with worldwide emergency transportation having a $250 copay. Preventive services, vision, and dental care are also included. Vision includes eye exams and eyewear with a 20% coinsurance for contact lenses, up to $300 per year. Dental services cover a variety of services, and the plan also covers home infusion, dialysis, and medical equipment. The plan covers home health services with no copay, and additional benefits include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $75 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, there is a $200 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital, observation, and ambulatory surgical center services, and outpatient substance abuse services, are covered. Individual and group sessions for outpatient substance abuse have a copay of $20. Outpatient blood services are also covered.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $20 copay. Prior authorization and a doctor's referral are required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $250 copay, and transportation services to plan-approved health-related locations, with a limit of 54 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by SCAN Classic (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $250 copay; all other services have no copay and no coinsurance.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care services, including primary care physician services, chiropractic services, occupational therapy services, 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 $10 copay for routine care, while occupational therapy services have a copay between $0 and $10. Individual and group sessions for mental health and psychiatric services have a copay between $0 and $20, and opioid treatment program services have a $20 copay. Physical therapy and speech-language pathology services have a copay between $0 and $10. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, Annual Physical Exams, and other preventive services, with some services requiring prior authorization or a doctor's referral. Additional benefits include coverage for Health Education, Personal Emergency Response System, Fitness Benefit, Remote Access Technologies, In-Home Support Services, and Support for Caregivers of Enrollees, while others like In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams are covered once per year. Fitting/evaluation for hearing aids is covered. Prescription hearing aids (all types) are covered with a copay between $550 and $850 for 2 visits per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eyewear has a 20% coinsurance for contact lenses, with a combined maximum plan benefit of $300 every year.
Dental Services See details
The SCAN Classic (HMO) plan covers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), 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, and Orthodontic Services have a maximum benefit of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs also have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetic Devices with 0% to 20% coinsurance, Medical Supplies with 0% to 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
The SCAN Classic (HMO) plan covers diagnostic and radiological services, though specific services are not covered. Diagnostic Radiological Services have a copay of up to $200, while Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by SCAN Classic (HMO), with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
SCAN Classic (HMO) does not cover Cardiac Rehabilitation Services. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN Classic (HMO), 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 $150. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The SCAN Classic (HMO) plan covers acupuncture with a $10 copay, up to 20 treatments per year, and also covers over-the-counter items up to $100 every three months, including nicotine replacement therapy and Naloxone. The plan also offers a meal benefit. However, other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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