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SCAN Classic WA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Classic WA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Classic WA (HMO) in 2026, please refer to our full plan details page.
SCAN Classic WA (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2026 to people living in Pierce, Thurston and Spokane Counties. The overall rating for this plan is not yet available for 2026.
It's important to know that SCAN Classic WA (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 WA (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 WA (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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 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 WA (HMO) Medicare Advantage plan features an annual prescription drug deductible of $250. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications, whether you fill your prescription at preferred pharmacies, standard pharmacies, or through mail order. This ensures highly affordable access to many common maintenance medications. For Tier 3 preferred brand drugs, copays start at $42 monthly at preferred pharmacies and preferred mail-order services, or $43 at standard pharmacies and standard mail-order. Higher-tier medications require coinsurance rather than a flat copay, with Tier 4 non-preferred drugs carrying a 35% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply.
Additional Benefits
The SCAN Classic WA (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and urgent care. For inpatient hospital stays, members pay a $425 daily copay for the first five days and no copay for days six through 90, with no coinsurance required. Outpatient hospital services require a copay of up to $425, while emergency room visits carry a $125 copay that is waived upon admission. Additionally, the plan provides key specialty and supplemental benefits, including preventive dental services and home health care with no copay and no coinsurance. Comprehensive dental is covered up to $1,500 annually with 0% to 50% coinsurance, and routine vision care offers no copay for eyewear up to a $175 annual limit. Hearing exams require a $35 copay, while everyday extras like over-the-counter items and meals are covered with no copay or coinsurance.
Inpatient Hospital See details
SCAN Classic WA (HMO) covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN Classic WA (HMO) with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $425, observation services cost a $425 copay per stay, and outpatient substance abuse individual or group sessions carry a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by SCAN Classic WA (HMO) with a $55.00 copay and no coinsurance, though prior authorization and referrals are required.
Ambulance and Transportation Services See details
SCAN Classic WA (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, with prior authorization required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
SCAN Classic WA (HMO) covers emergency services with a $125 copay, which is waived if admitted, and no coinsurance, while urgently needed services are covered with no copay or coinsurance. Worldwide emergency and urgent services are also covered with no coinsurance, carrying a $125 copay for emergency care and a $250 copay for emergency transportation.
Primary Care See details
SCAN Classic WA (HMO) primary care benefits are partially covered, featuring no copay and no coinsurance for primary care physician visits, while podiatry and other chiropractic services are not covered. Most other covered services, including specialist visits, physical therapy, and psychiatric services, require a copay of up to $35 and no coinsurance.
Preventive Services See details
SCAN Classic WA (HMO) offers coverage for preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive services are partially covered, offering health education and fitness benefits, while sub-services such as in-home safety assessments, medical nutrition therapy, and alternative therapies are not covered.
Hearing Services See details
Hearing Services are partially covered by SCAN Classic WA (HMO), featuring a $35 copay and no coinsurance for exams, and copays ranging from $550 to $850 with no coinsurance for up to two prescription hearing aids per year. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by SCAN Classic WA (HMO), offering routine eye exams with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $175 annual limit for contacts or eyeglasses, though upgrades are not covered.
Dental Services See details
SCAN Classic WA (HMO) covers preventive dental services with no copay and no coinsurance, and Medicare-covered dental services with a $35 copay and no coinsurance. Comprehensive dental services are covered up to a $1,500 annual maximum with no copay and 0% to 50% coinsurance, but other preventive services, endodontics, prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Classic WA (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs range from no coinsurance up to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by SCAN Classic WA (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required for these services.
Medical Equipment See details
Medical equipment is partially covered by SCAN Classic WA (HMO), featuring no copay and coinsurance ranging from no coinsurance to 20% for durable medical equipment, prosthetics, and medical supplies. Diabetic therapeutic shoes and inserts are covered with no copay and 20% coinsurance, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by SCAN Classic WA (HMO), as lab services are not covered. Diagnostic procedures and outpatient X-rays require a $10 copay with no coinsurance, diagnostic radiological services have no copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by SCAN Classic WA (HMO) with no copay and no coinsurance. Both prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
SCAN Classic WA (HMO) offers some covered cardiac rehabilitation services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copayments of $25 to $35.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN Classic WA (HMO) with no coinsurance, requiring no copay for days 1 to 20 and a $175 copay for days 21 to 100. This benefit is partially covered because additional days beyond Medicare-covered care are not covered, and prior authorization and referrals are required.
Other Services See details
Other services are partially covered under the SCAN Classic WA (HMO), excluding Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services. Covered benefits include acupuncture with a $20 copay and no coinsurance for up to 10 annual treatments, alongside OTC items and meal benefits which both feature no copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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