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SCAN MyChoice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN MyChoice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN MyChoice (HMO) in 2025, please refer to our full plan details page.
SCAN MyChoice (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 MyChoice (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 MyChoice (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 MyChoice (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 MyChoice (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying costs depending on the drug tier and pharmacy type. Preferred and standard generic drugs have a copay of $0 or $42-43, while preferred brand drugs have a 50% coinsurance, and non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0 for all drugs.
Additional Benefits
The SCAN MyChoice (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $150 copay for the first five days, and then no copay for the next 85 days, while outpatient services have copays ranging from $20 to $175. Emergency services have a $90 copay, and primary care visits, including chiropractic and physical therapy, have a $20 copay. The plan also covers hearing exams for $20, and offers partial coverage for prescription hearing aids with copays between $550 and $850. Vision services include eye exams for $20 and up to $200 per year for eyewear. Additionally, dental services have a $20 copay, and other services such as acupuncture, home health, and skilled nursing facilities are covered with different cost structures.
Inpatient Hospital See details
Inpatient Hospital coverage includes both acute and psychiatric care, and requires prior authorization and a doctor's referral. For days 1-5, there is a $150 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, and outpatient blood services. Outpatient hospital services have a copay between $20 and $175, while ambulatory surgical center services have no copay. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN MyChoice (HMO) with a $55 copay, and requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
The SCAN MyChoice (HMO) plan covers ambulance services with a $250 copay for both ground and air ambulance services, and no coinsurance. 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 by the SCAN MyChoice (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; all services have no coinsurance.
Primary Care See details
The SCAN MyChoice (HMO) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy (with a $20 copay), physician specialist services (with a $20 copay), physical therapy and speech-language pathology services (with a $20 copay), and additional telehealth benefits (with a copay between $0 and $20). Mental health specialty services, psychiatric services, and podiatry services are not covered.
Preventive Services See details
The SCAN MyChoice (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 include routine hearing exams with a $20 copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are partially covered, with a copay between $550 and $850 for all types of prescription hearing aids except for inner ear, outer ear, and over the ear hearing aids, which are not covered.
Vision Services See details
Vision services are covered, including eye exams with a $20 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, with a combined maximum benefit of $200 per year. Upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers Medicare dental services with a $20 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. Fluoride treatment, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum benefit coverage of $2000 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN MyChoice (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the SCAN MyChoice (HMO) plan and require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment includes Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The SCAN MyChoice (HMO) plan covers diagnostic and radiological services. Diagnostic procedures, tests, and lab services are not covered. Diagnostic Radiological Services have a copay of up to $175, while Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the SCAN MyChoice (HMO) plan, with no copay or coinsurance. 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 MyChoice (HMO) plan. The plan does not cover any Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $75. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the SCAN MyChoice (HMO) plan, acupuncture is covered with a $15 copay, and you can get up to 20 treatments per year. Over-the-counter items are covered up to $45 every three months, and meal benefits are available following surgery or inpatient hospitalization and for chronic illness or medical conditions that require you to stay home. The plan does not cover 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, or Self-Directed Personal Assistance Services.
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