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SCAN Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Classic (HMO) in 2026, please refer to our full plan details page.
SCAN Classic (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Bernalillo and Sandoval Counties. The overall rating for this plan is not yet available for 2026.
It's important to know that SCAN Classic (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 (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 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2800.00 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 (HMO) Medicare plan offers a $0 prescription drug deductible, meaning your coverage begins immediately with no upfront deductible costs. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs, whether you use a preferred pharmacy, standard pharmacy, or mail-order service. This provides an affordable option for individuals relying primarily on generic prescription medications. For brand-name and specialty prescriptions, Tier 3 preferred brand drugs have a copayment starting at $42 for a one-month supply at preferred pharmacies or mail order, and $43 at standard locations. Tier 4 non-preferred drugs require a 35% coinsurance, while Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply across all pharmacy types. These clear cost-sharing tiers help you accurately estimate your monthly healthcare expenses.
Additional Benefits
The SCAN Classic (HMO) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for major services like inpatient hospital stays and outpatient care. Primary care visits, telehealth services, and preventive care are available with no copay, while specialist visits require a $20 copay. For inpatient hospital stays, members pay a $150 daily copay for the first five days and no copay for days 6 through 90. Beyond standard medical care, this plan provides valuable extra benefits including dental coverage with no copay up to a $3,000 annual limit and routine vision care with a $250 eyewear allowance. Members also receive up to 28 one-way transportation trips to approved health locations and a $65 quarterly over-the-counter allowance with no copay. Other essential services, such as home health care, require no copay and no coinsurance, ensuring affordable access to daily healthcare needs.
Inpatient Hospital See details
SCAN Classic (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 to 5 and no copay for days 6 to 90. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
SCAN Classic (HMO) covers outpatient hospital services with a $20.00 to $175.00 copay and no coinsurance, while ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance. Outpatient substance abuse services are not covered, as both individual and group sessions are not covered.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $55 copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by SCAN Classic (HMO), with ground and air ambulance services requiring a $250 copay and no coinsurance. Transportation services are partially covered, offering up to 28 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services under the SCAN Classic (HMO) plan are covered with a $90 copay and no coinsurance, which is waived if you are immediately admitted to the hospital. Urgently needed services are covered with a $10 copay and no coinsurance, while worldwide emergency services feature no coinsurance and copays of $90 for emergency care, $10 for urgent care, and $250 for emergency transportation.
Primary Care See details
SCAN Classic (HMO) covers primary care physician services, telehealth, and opioid treatment with no copay and no coinsurance, while specialist and therapy visits require a $20 copay and no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance for up to 20 routine visits, but other chiropractic services and podiatry are not covered. Some mental health and psychiatric services are covered with no copay and no coinsurance, but individual and group sessions for these services are not covered.
Preventive Services See details
Preventive services are covered by SCAN Classic (HMO) with no copay and no coinsurance for exams, screenings, and kidney disease education. This benefit is partially covered, as it excludes in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
SCAN Classic (HMO) provides hearing services that include routine exams for a $20 copay and no coinsurance, as well as partially covered prescription hearing aids with a copay of $450 to $750 and no coinsurance. Under this plan, over-the-counter (OTC) hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
SCAN Classic (HMO) covers vision services with no deductibles and no coinsurance, offering routine eye exams for a $0 to $20 copay and eyewear with no copay up to a $250 annual maximum. While routine exams and basic eyewear are covered, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under the SCAN Classic (HMO) plan, with Medicare-covered dental services requiring a $20 copay and no coinsurance, and other covered preventive and comprehensive services requiring no copay and no coinsurance up to a $3,000 annual limit. 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 Classic (HMO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, insulin, and other drugs feature coinsurance ranging from no coinsurance to 20%, with insulin drugs also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by SCAN Classic (HMO) with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Medical equipment is covered by SCAN Classic (HMO) with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered because durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
SCAN Classic (HMO) partially covers diagnostic and radiological services, requiring referrals and prior authorization for covered services. Covered diagnostic and diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services require a 20% coinsurance; however, diagnostic procedures, lab services, and outpatient X-rays are not covered.
Home Health Services See details
SCAN Classic (HMO) covers home health services with no copay and no coinsurance, although prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by SCAN Classic (HMO) with no coinsurance and a $20 copay, though only some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These services require prior authorization and a referral.
Skilled Nursing Facility (SNF) See details
SCAN Classic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $75 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
SCAN Classic (HMO) offers other services including acupuncture for a $15 copay and no coinsurance up to 20 treatments per year, alongside meal benefits and over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and the over-the-counter benefit provides a $65 allowance every three months.
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