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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 Maricopa, Pima and Pinal Counties. This plan received an overall rating of 4.5 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 $2000.00 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 features an enhanced alternative drug benefit with no prescription drug deductible. During the initial coverage phase, members enjoy no copay for tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, compared to a $9 copay at standard locations. Tier 2 standard generic drugs require a $42 copay at preferred locations and a $47 copay at standard locations, while tier 3 and tier 4 drugs require a 35% and 33% coinsurance, respectively. These cost-sharing rates apply until your total yearly drug expenses reach $2,100. Once your yearly out-of-pocket spending reaches this $2,100 limit, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, those who qualify for the low-income subsidy can reduce their Part D premium cost to $0.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers robust medical coverage with many essential services featuring no copayments, including preventive care, urgent care, and routine eye and hearing exams. For inpatient hospital stays, members pay a $75 daily copay for the first five days, while primary care and outpatient services feature low to no copays. Emergency care is also highly accessible with a $90 copay that is waived upon hospital admission. This plan also provides valuable extra benefits, including dental coverage up to a $3,000 annual maximum, a $300 annual eyewear allowance, and up to 56 one-way trips to plan-approved health locations. Additional perks feature a $60 monthly allowance for over-the-counter items, routine acupuncture for a $10 copay, and skilled nursing care with no copay for the first 20 days. These comprehensive offerings help ensure predictable healthcare costs and support your overall well-being.
Inpatient Hospital See details
SCAN Balance (HMO C-SNP) partially covers inpatient hospital services, with exclusions for upgrades and non-Medicare-covered stays. Acute inpatient stays require a $75 daily copay for days 1 to 5, followed by no copay for days 6 to 90 and no coinsurance. Psychiatric inpatient stays require a $200 daily copay for days 1 to 7, followed by no copay for days 8 to 90 and no coinsurance.
Outpatient Services See details
Outpatient services are covered by SCAN Balance (HMO C-SNP), including outpatient hospital, observation, ambulatory surgical center, and blood services with no deductible or coinsurance. Outpatient substance abuse services are covered with a $20 copay per individual or group session and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by SCAN Balance (HMO C-SNP) with a $20 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by SCAN Balance (HMO C-SNP), with ground and air ambulance services requiring a $250 copay and no coinsurance. Transportation benefits are partially covered, providing up to 56 one-way trips per year to plan-approved health-related locations, 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 admitted to the hospital. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency care and transportation are offered with copays of $90 and $250, respectively, and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by SCAN Balance (HMO C-SNP) with no coinsurance and copays ranging from no copay up to $20, though podiatry services are not covered. Covered services include routine chiropractic care for a $10 copay for up to 20 visits yearly, physical and occupational therapy with copays ranging from no copay to $10, and mental health or psychiatric sessions with copays ranging from no copay to $20.
Preventive Services See details
SCAN Balance (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for Medicare-covered zero-dollar services. While annual physical exams and health education are included, several sub-services—including medical nutrition therapy, alternative therapies, therapeutic massage, weight management, and adult day health—are not covered.
Hearing Services See details
Hearing services are covered under SCAN Balance (HMO C-SNP), featuring annual routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered for up to two devices per year with a copay between $350 and $650 and no coinsurance, while OTC hearing aids and inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by SCAN Balance (HMO C-SNP), as eyewear upgrades are not covered. Routine eye exams are covered annually with no deductible, no copay, and no coinsurance, while eyewear is covered up to $300 annually with no deductible, no copay, and a 20% coinsurance for contact lenses.
Dental Services See details
SCAN Balance (HMO C-SNP) provides partially covered dental services, which include preventive care and comprehensive treatments up to a $3,000 annual maximum, though orthodontics is not covered. Copay and coinsurance details are not specified, and prior authorization is required for Medicare dental and comprehensive services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SCAN Balance (HMO C-SNP) with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for Medicare Part B insulin drugs. Covered Part B chemotherapy, radiation, and other drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Balance (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
SCAN Balance (HMO C-SNP) covers durable medical equipment and prosthetics with no copay and coinsurance ranging from no coinsurance to 20%. Diabetic equipment is not covered by the plan, as diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by SCAN Balance (HMO C-SNP), though diagnostic procedures, lab services, and outpatient X-rays are not covered. Covered diagnostic radiological services require a copay of $0 to $50 and no coinsurance, while therapeutic radiological services require a 20% coinsurance and a copay. Prior authorization and doctor referrals are required for all covered services.
Home Health Services See details
Home Health Services are covered by the SCAN Balance (HMO C-SNP) plan, requiring prior authorization and a doctor referral. Specific copay and coinsurance costs for these services are not specified in the available plan details.
Cardiac Rehabilitation Services See details
SCAN Balance (HMO C-SNP) does not cover Cardiac Rehabilitation Services, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
SCAN Balance (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services, offering no copay or coinsurance for days 1 through 20, and a $150 daily copay with no coinsurance for days 21 through 100. Prior authorization and a doctor referral are required, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
SCAN Balance (HMO C-SNP) provides partial coverage for other services, including acupuncture for a $10 copay and no coinsurance for up to 20 visits per year, and a $60 monthly allowance for over-the-counter items with no copay or coinsurance. Post-hospitalization meal benefits are also covered with no copay or coinsurance, but highly integrated services for dual eligible SNPs are not covered.
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