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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 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 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. Additionally, this plan comes with a Part B Premium reduction of $30.00. 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 $2500.00 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) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. During the initial coverage phase, Tier 1 preferred generic drugs have no copay at preferred and standard pharmacies, as well as through mail order. Tier 2 standard generic drugs require a $42 copay at preferred pharmacies and preferred mail order, or a $43 copay at standard pharmacies and standard mail order. For higher-tier medications, Tier 3 preferred brand drugs carry a 35% coinsurance, while Tier 4 non-preferred drugs require a 33% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs.
Additional Benefits
The SCAN MyChoice (HMO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs, typically featuring no coinsurance for primary care and hospital stays. Inpatient hospital stays require a $105 daily copay for the first five days and no copay for days six through 90, while primary care visits range from no copay up to $20. Emergency care is covered with a $90 copay, which is waived if you are admitted, and urgent care services require no copay. For specialized care, outpatient hospital services carry a $50 copay, and skilled nursing facility stays have no copay for the first 20 days. Preventive services, routine vision exams, and routine hearing tests are all covered with no copay, helping you manage your wellness affordably. Additionally, services such as dialysis and durable medical equipment are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
SCAN MyChoice (HMO) partially covers inpatient hospital services with no coinsurance, charging a $105 daily copay for days 1 to 5 of acute stays (no copay for days 6 to 90) and a $200 daily copay for days 1 to 7 of psychiatric stays (no copay for days 8 to 90). Upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by SCAN MyChoice (HMO), featuring a $50 copay and no coinsurance for outpatient hospital and ambulatory surgical center services, and a $20 copay with no coinsurance for substance abuse sessions. Outpatient blood services are also covered with no copay, no coinsurance, and no deductible, though most of these services require prior authorization and a doctor referral.
Partial Hospitalization See details
SCAN MyChoice (HMO) covers partial hospitalization benefits 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
SCAN MyChoice (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. For transportation benefits, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
SCAN MyChoice (HMO) covers emergency services with a $90 copay and no coinsurance, and the copay is waived if you are admitted to the hospital. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency coverage and worldwide emergency transportation are available with copays of $90 and $250 respectively, and no coinsurance.
Primary Care See details
SCAN MyChoice (HMO) offers partially covered primary care benefits, as podiatry services are not covered under this plan. Covered services require no coinsurance, with copays ranging from no copay to $20 depending on the service, such as a $10 copay for routine chiropractic care.
Preventive Services See details
SCAN MyChoice (HMO) covers preventive services with no copay or coinsurance, though prior authorization and referrals are required for certain services. This benefit is partially covered, as the plan does not cover in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional smoking cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling services.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), which does not cover OTC hearing aids or prescription hearing aids for the inner ear, outer ear, and over the ear. Covered routine exams and fitting evaluations require no copay or coinsurance, while covered prescription hearing aids require a copay of $550 to $850 and no coinsurance.
Vision Services See details
Vision services are partially covered by SCAN MyChoice (HMO), offering one routine eye exam per year with no deductible, no copay, and no coinsurance. Eyewear is covered with no copay and a combined maximum benefit of $250 every three months, though contact lenses require a 20% coinsurance and upgrades are not covered.
Dental Services See details
Dental services are partially covered by SCAN MyChoice (HMO), as orthodontics is not covered under the plan. While specific copay and coinsurance details are not specified in the plan terms, coverage includes preventive exams, cleanings, and prior-authorized Medicare dental services, with orthodontic services limited to a $250 maximum benefit every three months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SCAN MyChoice (HMO) with prior authorization, featuring no coinsurance to 20% coinsurance and no copay for chemotherapy, radiation, and other Part B drugs. Covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN MyChoice (HMO) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required for coverage.
Medical Equipment See details
SCAN MyChoice (HMO) covers medical equipment, including durable medical equipment, prosthetic devices, and medical supplies, with no copay and coinsurance ranging from no coinsurance to 20% with prior authorization. Diabetic equipment is partially covered, as diabetic supplies are not covered, but diabetic therapeutic shoes and inserts are covered with no copay and 20% coinsurance.
Diagnostic and Radiological Services See details
SCAN MyChoice (HMO) partially covers Diagnostic and Radiological Services, requiring a doctor referral and prior authorization. Diagnostic radiological services require no coinsurance and a copay of up to $50, with no copay for some services, while therapeutic radiological services require a 20% coinsurance and a copay. Outpatient X-ray services are not covered, and although some diagnostic services are covered, diagnostic procedures and lab services are not covered in practice.
Home Health Services See details
Home Health Services are covered by the SCAN MyChoice (HMO) plan, though prior authorization and a doctor referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under SCAN MyChoice (HMO), meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice (HMO) partially covers Skilled Nursing Facility (SNF) services with no copay for days 1 to 20, a $150 daily copay for days 21 to 100, and no coinsurance. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN MyChoice (HMO), which offers acupuncture with a $10 copay and no coinsurance, alongside meal benefits and over-the-counter items with no copay or coinsurance. Highly integrated services for Dual Eligible SNPs are not covered under this benefit.
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