A non-government entity
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 2026, 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 2026.
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 $3300.00 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) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for any supply length, whether you use a preferred pharmacy, standard pharmacy, or mail-order service. For Tier 3 preferred brand drugs, copays start at $42 for a one-month supply through preferred pharmacies and mail-order, or $43 at standard pharmacies. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs at 35% coinsurance and Tier 5 specialty drugs at 33% coinsurance for a one-month supply.
Additional Benefits
The SCAN MyChoice (HMO) plan offers comprehensive coverage for everyday healthcare needs, featuring no copay for primary care visits, preventive care, home health services, and select dental and vision benefits. Specialist visits, physical therapy, and routine eye exams are also highly affordable, requiring a low $20 copay and no coinsurance. Additionally, members benefit from a $210 allowance every three months for vision and dental services with no copay. For emergency and inpatient care, the plan features a $90 emergency room copay and a $200 daily copay for the first five days of an inpatient hospital stay, with no copay thereafter. Specialized services such as dialysis and durable medical equipment are covered with a 20% coinsurance and no copay. Please note that while the plan covers many extra benefits like acupuncture and hearing aids, it does not cover cardiac rehabilitation, podiatry, or psychiatric services.
Inpatient Hospital See details
SCAN MyChoice (HMO) covers inpatient hospital services with no coinsurance, requiring a $200 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization and referrals are required, and while unlimited additional acute care days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN MyChoice (HMO) with no coinsurance, featuring a $20 to $200 copay for outpatient hospital services and no copay for ambulatory surgical center and blood services. Outpatient substance abuse services also feature no copay or coinsurance, though individual and group sessions are not covered.
Partial Hospitalization See details
SCAN MyChoice (HMO) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for these services, and a referral may also be required.
Ambulance and Transportation Services See details
SCAN MyChoice (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
SCAN MyChoice (HMO) covers emergency services with a $90 copay and no coinsurance, with the copay waived if you are immediately admitted to the hospital. Urgently needed services require a $10 copay with no coinsurance, and worldwide emergency services are covered with no coinsurance and copays of $90 for emergency care, $10 for urgent care, and $250 for emergency transportation.
Primary Care See details
Primary care services under SCAN MyChoice (HMO) feature no copay and no coinsurance for primary care provider visits and opioid treatment programs. Specialist visits, physical therapy, occupational therapy, and speech therapy require a $20 copay and no coinsurance, while routine chiropractic care is partially covered with a $15 copay and no coinsurance. Podiatry, psychiatric services, and specialty mental health services are not covered under this plan.
Preventive Services See details
SCAN MyChoice (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, excluding in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation counseling, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), which includes routine hearing exams for a $20 copay and no coinsurance, with prior authorization and referrals required. Up to two prescription hearing aids are covered annually with no coinsurance and a copay of $550 to $850, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
SCAN MyChoice (HMO) partially covers vision services with no deductibles, offering one routine eye exam per year with a $0 to $20 copay and no coinsurance, while other eye exams and eyewear upgrades are not covered. Eyewear is covered with no copay or coinsurance up to a $210 maximum limit every three months, subject to prior authorization and referral requirements.
Dental Services See details
Dental services are partially covered by SCAN MyChoice (HMO), offering Medicare-covered dental services for a $20 copay and no coinsurance, and most preventive and comprehensive services with no copay and no coinsurance up to a $210 maximum every three months. Other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN MyChoice (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs are covered with coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by SCAN MyChoice (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required for this benefit.
Medical Equipment See details
SCAN MyChoice (HMO) covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered because diabetic supplies are not covered, although durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered.
Diagnostic and Radiological Services See details
SCAN MyChoice (HMO) partially covers diagnostic and radiological services, requiring prior authorization and referrals, while excluding lab services, diagnostic procedures, and outpatient X-rays. Covered diagnostic and diagnostic radiological services feature no copay and no coinsurance, whereas therapeutic radiological services require both a copayment and 20% coinsurance.
Home Health Services See details
Home health services are covered by SCAN MyChoice (HMO) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under SCAN MyChoice (HMO), including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and a referral are required. There is no copay for days 1 through 20, followed by a $75 daily copay for days 21 through 100, with no coverage provided for additional days beyond the standard Medicare benefit.
Other Services See details
Other services covered by SCAN MyChoice (HMO) include acupuncture with a $15 copay and no coinsurance, as well as over-the-counter items and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while Dual Eligible SNPs with Highly Integrated Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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