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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 2025, 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 2025.
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) plan has a $0 deductible for prescription drugs. 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, while standard generic drugs have a $42 or $43 copay depending on the pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The SCAN Classic (HMO) plan offers a wide range of benefits with varying cost structures. Inpatient hospital stays have a copay, while outpatient services have a copay between $20 and $175. Emergency services have a copay of $90, and ambulance services have a copay of $250. The plan also includes coverage for primary care, hearing, vision, and dental services, with copays ranging from $15 to $20. Preventive services are covered with no copay. The plan also covers home health services, skilled nursing facilities, and some diagnostic services, with copays or coinsurance applying in certain situations.
Inpatient Hospital See details
The SCAN Classic (HMO) plan covers inpatient hospital stays with a $150 copay for days 1-5 and no copay for days 6-90, as well as inpatient hospital psychiatric stays with the same cost structure. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered by the SCAN Classic (HMO) plan with a copay of $20.00 - $175.00, while Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services are not covered, and Outpatient Blood Services are covered.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $55 copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $250 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 28 one-way trips per year, using rideshare services, bus/subway, or medical transport. 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 under the SCAN Classic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $10 copay, and Worldwide Emergency Transportation has a $250 copay, with no coinsurance for any of these services.
Primary Care See details
The SCAN Classic (HMO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $20 copay, Physical Therapy and Speech-Language Pathology Services with a $20 copay, Other Health Care Professional with a copay ranging from $0 to $20, and Opioid Treatment Program Services. Mental Health and Psychiatric Services are not covered. Additional Telehealth Benefits are covered with a copay ranging from $0 to $20.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered services with no copay, an annual physical exam, health education, personal emergency response systems, fitness benefits, remote access technologies, in-home support services, support for caregivers, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and kidney disease education services. In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by SCAN Classic (HMO), including routine hearing exams with a $20 copay. Prescription hearing aids are covered with a copay between $450 and $750, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The SCAN Classic (HMO) plan covers vision services, including eye exams with a $20 copay, and eyewear with a combined maximum benefit of $250 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, with a limit of one pair or set annually. Upgrades are not covered.
Dental Services See details
The SCAN Classic (HMO) plan covers dental services, including oral exams with a $20 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and orthodontic services up to a maximum of $2000 per year. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Classic (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B Drugs with 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered devices and supplies, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance and no copay; however, DME for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests, and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $175.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the SCAN Classic (HMO) plan with no copay and no coinsurance, but require authorization and a referral. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the SCAN Classic (HMO) plan. Prior authorization and a doctor's referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Classic (HMO) plan with a doctor referral and prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $75. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The SCAN Classic (HMO) plan covers acupuncture with a $15 copay for up to 20 treatments per year, and also covers over-the-counter (OTC) items with a maximum benefit of $60 every three months. Meal benefits are also covered. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and other services are not covered.
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