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SCAN Venture (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Venture (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Venture (HMO) in 2025, please refer to our full plan details page.
SCAN Venture (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 Venture (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 Venture (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 Venture (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. Additionally, this plan comes with a Part B Premium reduction of $50.00. You must continue to pay paying your reduced 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 $2999.00 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 Venture (HMO) plan has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a $42 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your premium may be reduced to $0.00.
Additional Benefits
The SCAN Venture (HMO) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a copay, while outpatient services range from no copay to $250. Emergency, urgent, and ambulance services are covered with copays, and primary care, including chiropractic and mental health, is included, with copays varying by service. Preventive services, vision, dental, and hearing services are also covered, with varying copays and coinsurance. The plan also covers home health, skilled nursing, dialysis, and medical equipment, along with other services like acupuncture and over-the-counter items. Some services require prior authorization or a doctor's referral, and some services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services; Inpatient Hospital-Acute has a $250 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has 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, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $30-$250 copay, observation services, ambulatory surgical center services with no copay, outpatient substance abuse services with a $30 copay for individual and group sessions, and outpatient blood services. Prior authorization and a doctor referral are required for most services.
Partial Hospitalization See details
Partial Hospitalization is covered under the SCAN Venture (HMO) plan, with a $30 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Venture (HMO) plan, with a $250 copay for both ground and air ambulance services and no coinsurance. 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 the SCAN Venture (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $20 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
SCAN Venture (HMO) covers primary care services, including chiropractic, occupational therapy, and mental health services. Chiropractic services have a $20 copay, and routine chiropractic care has a $5 copay for up to 20 visits per year. Specialist, mental health, and psychiatric services have copays ranging from $0 to $30, and physical therapy and speech-language pathology services have a copay between $0 and $30. Additional telehealth benefits are covered with a copay between $0 and $30, and Opioid Treatment Program Services have a $20 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including annual physical exams, are covered, and some services not usually covered by Medicare are also included. Health education, support for caregivers of enrollees, fitness benefits, and remote access technologies are covered, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services under the SCAN Venture (HMO) plan includes routine hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $550 and $850 depending on the type, but does not cover hearing aids for the inner ear, outer ear, or over the ear. Routine hearing exams are limited to 1 per year, and prescription hearing aids are limited to 2 per year.
Vision Services See details
Vision Services include eye exams with a copay of $0-$20 and eyewear with 20% coinsurance for contact lenses; eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The SCAN Venture (HMO) plan covers oral exams and dental x-rays with a limit of 2 visits per year, other diagnostic dental services, prophylaxis (cleaning) with a limit of 2 visits per year, other preventive dental services, orthodontic services, adjunctive general services, and periodontics; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are offered as optional, supplemental benefits.
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 with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the SCAN Venture (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 benefits with the SCAN Venture (HMO) plan include Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetics/Medical Supplies with 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. This plan has no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by SCAN Venture (HMO), but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay up to $200, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the SCAN Venture (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization and referral are required for this benefit.
Cardiac Rehabilitation Services See details
SCAN Venture (HMO) does not cover Cardiac Rehabilitation Services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $184 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under Other Services, SCAN Venture (HMO) covers acupuncture with a $5 copay, and also covers over-the-counter (OTC) items with a maximum benefit of $55 every three months, and meal benefits. Some services are covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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