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SCAN Strive (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Strive (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 Strive (HMO C-SNP) in 2025, please refer to our full plan details page.
SCAN Strive (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 2025.
It's important to know that SCAN Strive (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 Strive (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 Strive (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 Strive (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.80. 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 $590.00 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 $9350.00 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 Strive (HMO C-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you'll pay a coinsurance for your medications. For preferred generic drugs, there is no copay. For standard generic drugs, you will pay 24-25% coinsurance, and for preferred brand drugs, you will pay 45% coinsurance.
Additional Benefits
The SCAN Strive (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. You'll pay 20% coinsurance for outpatient services, emergency services, primary care, hearing exams, vision exams and eyewear, dental, ambulance, and dialysis services. The plan also provides coverage for home infusion services, with copays and coinsurance depending on the specific services. Additional benefits include coverage for home health services with no copay or coinsurance, and durable medical equipment. You'll also have access to preventive services, including annual physical exams, and other services like over-the-counter items, offering a monthly benefit of $55.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the SCAN Strive (HMO C-SNP) plan, but additional days, non-Medicare covered stays, and upgrades for inpatient hospital acute and psychiatric are not covered. Prior authorization and a doctor's referral are required.
Outpatient Services See details
Outpatient Services for SCAN Strive (HMO C-SNP) covers outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services with a 20% coinsurance. Outpatient substance abuse services are partially covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Strive (HMO C-SNP) plan, but requires prior authorization and a doctor's referral. The plan does not mention any cost sharing for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered for up to 48 one-way trips per year, using rideshare services, bus/subway, or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Urgently Needed Services, you will pay 20% coinsurance. For Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, you will pay 20% coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services are not covered. Additional Telehealth Benefits have a coinsurance between 0% and 20%. Podiatry Services are not covered.
Preventive Services See details
The SCAN Strive (HMO C-SNP) plan covers preventive services including annual physical exams, health education, and fitness benefits. The plan also covers kidney disease education services with 20% coinsurance, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. In-home safety assessment, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, 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 partially covered by the SCAN Strive (HMO C-SNP) plan, with hearing exams requiring prior authorization and a doctor referral, and a coinsurance of at most 20%. Routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, have a 20% coinsurance, with a combined maximum benefit of $300 per year; contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each covered once per year. Upgrades are not covered.
Dental Services See details
The SCAN Strive (HMO C-SNP) plan covers Medicare Dental Services with 20% coinsurance. Other Dental Services include coverage for Oral Exams (2 visits per year), Dental X-Rays (1 per year), Other Diagnostic Dental Services, Prophylaxis (Cleaning) (2 visits per year), and Orthodontic Services, with a maximum benefit of $3,000 per year. Fluoride Treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the SCAN Strive (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and no copay, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Strive (HMO C-SNP) plan with no copay and no coinsurance, but require authorization and a referral. 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 Strive (HMO C-SNP) plan. Prior authorization and a doctor referral are required for Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered for SNF, nor does it cover non-Medicare-covered stays.
Other Services See details
Under the SCAN Strive (HMO C-SNP) plan, acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-Counter (OTC) Items and Meal Benefits are covered, with OTC items offering a maximum plan benefit coverage amount of $55.00 every month.
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