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SCAN MyChoice WA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN MyChoice WA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN MyChoice WA (HMO) in 2026, please refer to our full plan details page.
SCAN MyChoice 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 MyChoice 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 MyChoice 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 MyChoice 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 MyChoice WA (HMO) prescription drug plan features an annual drug deductible of $250. Members benefit from no copay for both Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs, whether filled at preferred, standard, or mail-order pharmacies for up to a three-month supply. This makes essential generic medications highly accessible and affordable. For Tier 3 (Preferred Brand) drugs, copays start at $42 for a one-month supply at preferred or mail-order pharmacies, and $43 at standard pharmacies. Tier 4 (Non-Preferred) drugs require a 35% coinsurance across all pharmacy options, while Tier 5 (Specialty) medications carry a 30% coinsurance for a one-month supply. These clear cost-sharing tiers help you easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The SCAN MyChoice WA (HMO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, urgent care, and annual preventive exams. For specialized medical needs, members pay a $35 copay for specialists and a $125 copay for emergency services, while inpatient hospital stays require a $440 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services and diagnostic procedures are also highly accessible, featuring no coinsurance and low-to-no copays for many common services. Beyond standard medical care, this plan provides excellent supplemental benefits, including preventive and comprehensive dental care up to a $1,000 annual limit and eyewear coverage up to $200 every three months with no copay. Members also benefit from a $35 copay for routine hearing exams, prescription hearing aid coverage, and home health services with no copay. Other convenient perks like over-the-counter items and home-delivered meals are included at no cost, though it is important to note that routine transportation and diabetic supplies are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is partially covered by SCAN MyChoice WA (HMO) with no coinsurance, requiring a $440 copay for days 1 through 5 and no copay for days 6 through 90. While acute and psychiatric stays are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN MyChoice WA (HMO) covers outpatient services with no coinsurance, featuring a $0 to $440 copay for outpatient hospital services and a $440 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay, while outpatient substance abuse individual and group sessions require a $35 copay.
Partial Hospitalization See details
SCAN MyChoice WA (HMO) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Ambulance and Transportation Services See details
SCAN MyChoice WA (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
SCAN MyChoice WA (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived upon immediate hospital admission, and urgently needed services with no copay and no coinsurance. Worldwide emergency coverage is available with a $125 copay, and worldwide emergency transportation is covered with a $250 copay, both featuring no coinsurance.
Primary Care See details
SCAN MyChoice WA (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance. Chiropractic services are partially covered with a $20 copay for routine care (other chiropractic services are not covered), telehealth and other health professionals range from a $0 to $35 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
SCAN MyChoice WA (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive services are partially covered with no copay or coinsurance, excluding services such as weight management, therapeutic massage, alternative therapies, in-home safety assessments, and home safety modifications.
Hearing Services See details
Hearing services under SCAN MyChoice WA (HMO) are partially covered with no deductible, offering annual routine exams for a $35 copay and no coinsurance, and up to two prescription hearing aids per year for a $550 to $850 copay and no coinsurance. However, OTC hearing aids and 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 MyChoice WA (HMO), featuring one routine eye exam per year with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 maximum benefit every three months, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by SCAN MyChoice WA (HMO), with Medicare-covered dental requiring a $35 copay and no coinsurance, and other covered preventive and comprehensive services having no copay and no coinsurance up to a $1,000 annual maximum. While oral exams, cleanings, and restorative treatments are covered, other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN MyChoice WA (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN MyChoice WA (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
SCAN MyChoice WA (HMO) covers medical equipment with no copay and coinsurance ranging from no coinsurance to 20%, with prior authorization required for most items. This benefit is partially covered because durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by SCAN MyChoice WA (HMO), with the exception of lab services which are not covered. Members pay a $10 copay and no coinsurance for diagnostic procedures, a $10 copay for outpatient X-rays, no copay for diagnostic radiological services, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
SCAN MyChoice WA (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by SCAN MyChoice WA (HMO) with no coinsurance, but require prior authorization and a referral. While some services are covered, the plan does not cover standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice WA (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20, followed by a $175 daily copay for days 21 through 100, with no coverage for days beyond the Medicare-covered limit.
Other Services See details
SCAN MyChoice WA (HMO) provides other services including acupuncture with a $20 copay and no coinsurance (up to 10 treatments per year, prior authorization required), alongside over-the-counter items and a meal benefit with no copay and no coinsurance. Other supplemental services and dual eligible SNP benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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