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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 2026, 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 2026.
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 $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 $615.00 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 $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 Strive (HMO C-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one, two, or three-month supplies, whether filled at preferred or standard pharmacies or through mail order. This makes generic prescriptions highly affordable and accessible under this plan. For Tier 3 preferred brand drugs, you will pay a 24% coinsurance at preferred pharmacies and mail-order services, or a 25% coinsurance at standard pharmacies. Tier 4 non-preferred drugs require a 30% coinsurance across all pharmacy options, while Tier 5 specialty drugs incur a 25% coinsurance for a one-month supply. These structured cost-sharing tiers help you clearly understand your out-of-pocket costs for brand-name and specialty medications.
Additional Benefits
The SCAN Strive (HMO C-SNP) plan offers comprehensive medical coverage with no copays for primary care, specialist visits, and preventive services. For inpatient hospital stays, members pay a daily copay of $150 for the first five days and no copay for days six through ninety, while outpatient hospital services feature no coinsurance and a copay ranging from no copay to $175. Emergency care is available with a $90 copay, which is waived upon hospital admission, and urgent care visits require a $10 copay. This plan also includes valuable supplemental benefits, such as dental care with no copay for covered preventive and comprehensive services up to a $4,000 annual limit. Members benefit from routine vision exams with a copay ranging from no copay to $20, alongside a $300 annual allowance for eyewear with no copay. Additionally, the plan covers up to 48 one-way transportation trips per year to plan-approved locations and provides a $105 monthly allowance for over-the-counter items, both with no copays.
Inpatient Hospital See details
SCAN Strive (HMO C-SNP) inpatient hospital care is covered with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. While unlimited additional days are covered for acute stays, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
SCAN Strive (HMO C-SNP) covers outpatient hospital services with no coinsurance and a copay of $0 to $175, alongside ambulatory surgical and blood services with no copay and no coinsurance. While some outpatient substance abuse services are covered under the plan with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
SCAN Strive (HMO C-SNP) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required for these services, and a referral may also be required depending on the provider.
Ambulance and Transportation Services See details
SCAN Strive (HMO C-SNP) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Strive (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services require a $10 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $90, $10, and $250 respectively.
Primary Care See details
SCAN Strive (HMO C-SNP) covers primary care, specialist, and opioid treatment services with no copay and no coinsurance, while occupational, physical, and speech therapy require a $20 copay and no coinsurance. Telehealth services are available with a $0 to $10 copay and no coinsurance, but podiatry is not covered, chiropractic covers some services but excludes routine and other chiropractic care, and mental health and psychiatric benefits are partially covered, excluding individual and group sessions.
Preventive Services See details
Preventive Services are covered by SCAN Strive (HMO C-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. This benefit is partially covered, as several supplemental services—including in-home safety assessments, medical nutrition therapy, weight management programs, and alternative therapies—are not covered.
Hearing Services See details
Hearing services are partially covered under SCAN Strive (HMO C-SNP), which offers covered hearing exams with a $20 copay, no coinsurance, and no deductible. However, routine hearing exams, fitting and evaluations, and all prescription or over-the-counter hearing aids are not covered.
Vision Services See details
SCAN Strive (HMO C-SNP) vision services are partially covered with no deductibles, featuring a $0 to $20 copay and no coinsurance for one routine annual eye exam, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $300 annual maximum for contacts or glasses, but upgrades are excluded.
Dental Services See details
Dental services are partially covered by SCAN Strive (HMO C-SNP), featuring a $20 copay and no coinsurance for Medicare-covered dental and no copay or coinsurance for covered preventive and comprehensive services up to a $4,000 annual limit. However, other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Strive (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Strive (HMO C-SNP) with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
SCAN Strive (HMO C-SNP) covers medical equipment with no copays, featuring a 0% to 20% coinsurance for durable medical equipment and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by SCAN Strive (HMO C-SNP), as diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic and diagnostic radiological services require no copay and no coinsurance, while therapeutic radiological services require a copay and 20% coinsurance, with prior authorization and referrals required.
Home Health Services See details
Home Health Services are covered by SCAN Strive (HMO C-SNP) with no copay and no coinsurance. Both prior authorization and a referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by SCAN Strive (HMO C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN Strive (HMO C-SNP) with no coinsurance and do not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $75 daily copay for days 21 through 100, and prior authorization and referrals are required, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
SCAN Strive (HMO C-SNP) provides partial coverage for other services, which includes over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The plan features a $105 monthly allowance for OTC items, and prior authorization is required for the meal benefit.
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