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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 2025, 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 3.5 out of 5 stars in 2025.
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 has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at preferred pharmacies and preferred mail order, and a $9 copay at standard pharmacies and standard mail order. For standard generic drugs, you will pay a $42 copay at preferred pharmacies and preferred mail order, and a $47 copay at standard pharmacies and standard mail order. For preferred brand drugs and non-preferred drugs, you will pay coinsurance of 50% and 33% respectively.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services, including substance abuse treatment, have copays between $20.00 and $20.00. Emergency services have copays, and primary care services such as chiropractic, mental health, and physical therapy have copays ranging from $0 to $20. Preventative services are covered, as are hearing, vision, and dental services with copays or coinsurance depending on the service. Additional benefits include ambulance services with a $250 copay, and home health services with no copay. The plan also offers coverage for home infusion, dialysis, and medical equipment with coinsurance. Other services, such as acupuncture and over-the-counter items, are also covered with copays or limits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $75 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $200 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services are covered. Individual and group sessions for outpatient substance abuse have a copay between $20.00 and $20.00, and outpatient blood services are also covered with a waived deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Balance (HMO C-SNP) plan, with a $20 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including Medicare-covered ground and air ambulance services, with a $250 copay for each service. Transportation Services to a plan-approved health-related location are covered for up to 56 one-way trips per year using various modes of transportation, but 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 under the SCAN Balance (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, and Worldwide Emergency Transportation has a $250 copay, while Urgently Needed Services has no copay. There is no coinsurance for any of these services.
Primary Care See details
The SCAN Balance (HMO C-SNP) plan covers primary care services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $10 copay for routine care. Individual and group sessions for mental health and psychiatric services have a copay between $0 and $20. Physical therapy and speech-language pathology services have a copay between $0 and $10. Opioid treatment program services have a $20 copay.
Preventive Services See details
The SCAN Balance (HMO C-SNP) plan covers preventive services including annual physical exams, health education, in-home safety assessments, personal emergency response systems, fitness benefits, remote access technologies, support for caregivers of enrollees, and in-home support services. The plan does not cover medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services are covered, including hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $550 and $850, 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
The SCAN Balance (HMO C-SNP) plan covers vision services, including routine eye exams once per year with no copay. Eyewear is covered with a 20% coinsurance for contact lenses and an annual maximum benefit of $300.
Dental Services See details
Dental services include coverage for oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, and prophylaxis (cleaning) (2 visits per year). This plan does not cover fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics. Orthodontic services have a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Balance (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, Prosthetics and Medical Supplies with 0% to 20% coinsurance and no copay, and Diabetic Equipment, but services such as Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Prior authorization is required for some services.
Diagnostic and Radiological Services See details
The SCAN Balance (HMO C-SNP) plan covers diagnostic and radiological services, but not diagnostic procedures/tests, lab services, or outpatient X-ray services. Diagnostic Radiological Services have a copay of up to $200, and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the SCAN Balance (HMO C-SNP) plan with no copay and no coinsurance, but require authorization and referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, 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 are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $10 copay and is limited to 20 treatments per year. OTC items are covered up to a maximum of $100 every three months, and the plan also offers nicotine replacement therapy and Naloxone. The meal benefit is available for specific circumstances such as after surgery or hospitalization. Several other services are not covered.
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