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SCAN Balance (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Balance (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Balance (HMO C-SNP) in 2026, please refer to our full plan details page.
SCAN Balance (HMO C-SNP) is a HMO C-SNP 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 Balance (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
SCAN Balance (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about SCAN Balance (HMO C-SNP).
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 Balance (HMO C-SNP), 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 Balance (HMO C-SNP) plan offers prescription drug coverage with a $0 drug deductible, meaning your coverage begins immediately without any out-of-pocket deductible costs. Generics are highly affordable, featuring no copay for both Tier 1 preferred generic and Tier 2 generic drugs across all preferred, standard, and mail-order pharmacies. For brand-name and specialty medications, costs vary depending on the drug tier and your choice of pharmacy. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies and mail-order services, or a $43 copay at standard pharmacies. Tier 4 non-preferred drugs carry a 35% coinsurance, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers robust coverage with predictable, low-cost sharing, featuring no copay and no coinsurance for primary care, preventive services, and home health care. Inpatient hospital stays require a $150 daily copay for the first five days and no copay thereafter, while specialist visits and outpatient services range from no copay up to a $175 copay. Emergency care is available with a $90 copay, and urgent care costs just a $10 copay, with no coinsurance for either service. Members also benefit from valuable everyday extras, including up to thirty one-way transportation trips and a dental benefit with no copay or coinsurance up to a $3,000 annual limit. Routine vision exams and eyewear are covered with no copay up to $250 annually, while routine hearing exams require a $20 copay. Additionally, the plan covers select over-the-counter items and meals with no copay, providing comprehensive wellness support.
Inpatient Hospital See details
SCAN Balance (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric stay days are not covered.
Outpatient Services See details
SCAN Balance (HMO C-SNP) covers ambulatory surgical center and outpatient blood services with no copay and no coinsurance, while outpatient hospital services require no coinsurance and a copay between $0 and $175. Outpatient substance abuse services are not covered in practice because individual and group sessions are not covered, and most covered services require prior authorization and referrals.
Partial Hospitalization See details
SCAN Balance (HMO C-SNP) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization and referrals are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by SCAN Balance (HMO C-SNP), with ground and air ambulance services requiring a $250 copay and no coinsurance. Transportation benefits are partially covered with no copay and no coinsurance for up to 30 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
SCAN Balance (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, which is waived if you are immediately admitted to the hospital. Urgently needed services require a $10 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $10 for urgent care, $90 for emergency care, and $250 for emergency transportation.
Primary Care See details
SCAN Balance (HMO C-SNP) covers primary care and opioid treatment with no copay and no coinsurance, while specialists, physical and occupational therapy, and telehealth cost $0 to $20 with no coinsurance. Chiropractic care is partially covered with a $15 to $20 copay and no coinsurance, excluding other chiropractic services, and podiatry is not covered. Some psychiatric and mental health specialty services are covered with no copay and no coinsurance, though individual and group sessions are not covered.
Preventive Services See details
Preventive services are covered by SCAN Balance (HMO C-SNP) with no copay and no coinsurance, although some services require prior authorization or referrals. Additional preventive services are partially covered, excluding in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Balance (HMO C-SNP), offering annual routine hearing exams for a $20 copay and no coinsurance, and up to two prescription hearing aids per year with a copay ranging from $450 to $750 and no coinsurance. There is no deductible for these services, but over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
SCAN Balance (HMO C-SNP) offers partially covered vision services, which include one routine eye exam per year with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $250 annual limit for contacts or eyeglasses, though upgrades are not covered.
Dental Services See details
SCAN Balance (HMO C-SNP) offers partially covered dental services with a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $3,000 annual maximum. However, other diagnostic dental services, other preventive dental services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered under SCAN Balance (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by SCAN Balance (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the SCAN Balance (HMO C-SNP) plan with no copays, though prior authorization is required. Durable medical equipment has a 0% to 20% coinsurance, prosthetics and medical supplies carry a 20% coinsurance, and diabetic equipment is partially covered with a 20% coinsurance for therapeutic shoes and inserts while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
SCAN Balance (HMO C-SNP) partially covers diagnostic and radiological services, requiring prior authorization and referrals. Covered diagnostic services have no copay and no coinsurance, though diagnostic procedures, tests, and lab services are not covered. Covered radiological services feature a $0 minimum copay for diagnostic radiological services, a copay and minimum 20% coinsurance for therapeutic radiological services, and exclude outpatient X-ray services.
Home Health Services See details
SCAN Balance (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
SCAN Balance (HMO C-SNP) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, although a referral and prior authorization are required. However, cardiac rehabilitation services, intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
SCAN Balance (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and a referral, and allowing admission without a prior three-day hospital stay. There is no copay for days 1 to 20, followed by a $75 copay for days 21 to 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
SCAN Balance (HMO C-SNP) partially covers other services, offering acupuncture with a $15 copay and no coinsurance, and over-the-counter items and select meal benefits with no copay and no coinsurance. Highly integrated services for dual eligible SNPs and other unspecified services are not covered.
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