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SCAN Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Classic (HMO) in 2025, please refer to our full plan details page.
SCAN Classic (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Ventura County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN Classic (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 Classic (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 Classic (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 $3000.00 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 Classic (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, you will have no copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the next phase. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The SCAN Classic (HMO) plan offers comprehensive coverage with a variety of benefits. It includes inpatient hospital care with a copay, outpatient services, and coverage for ambulance and emergency services with varying copays. Primary care, preventive services, vision, hearing, dental, and home health services are also covered. This plan also covers specialized services like partial hospitalization, home infusion, and dialysis, often requiring prior authorization. Additionally, you'll find coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities with specific cost-sharing arrangements. The plan provides extra benefits like acupuncture, over-the-counter items, and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits cover acute and psychiatric care, with a $300 copay for days 1-5 and no copay for days 6-90 for acute care, and a $250 copay for days 1-6 and no copay for days 7-90 for psychiatric care. Additional days and non-Medicare-covered stays for inpatient psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the SCAN Classic (HMO) plan, including outpatient hospital services with a copay ranging from $10 to $275, ambulatory surgical center services with a $10 copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services. Prior authorization and a doctor's referral are required for all services.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $55 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Classic (HMO) plan. Ground and air ambulance services each have a $225 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered for 32 one-way trips per year, using rideshare services, bus/subway, or medical transport, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by SCAN Classic (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have an $8 copay, and Worldwide Emergency Transportation has a $225 copay; all services have no coinsurance.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $5 copay, and physical therapy and speech-language pathology services with a $5 copay. The plan also covers physician specialist services, mental health specialty services, psychiatric services, and opioid treatment program services, all of which may have a copay. Additionally, the plan covers additional telehealth benefits with a copay between $0 and $10.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay and additional services such as Health Education, Personal Emergency Response System (PERS), Support for Caregivers of Enrollees, Fitness Benefit, and Remote Access Technologies, all of which are covered. Other services such as 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, In-Home Support Services, 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 $10 copay, and a fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $450 and $750 for up to 2 hearing aids per year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
The SCAN Classic (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum plan benefit of $175 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, with the plan covering one pair of each annually. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $10 copay, plus Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, and Prophylaxis (Cleaning). Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Restorative Services, Endodontics, Prosthodontics, fixed, and Oral and Maxillofacial Surgery are offered as optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN Classic (HMO), including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by SCAN Classic (HMO) with prior authorization and a doctor referral required. You will pay a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, Prosthetic Devices with 0% to 20% coinsurance and no copay, and Medical Supplies with 0% to 20% coinsurance and no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the SCAN Classic (HMO) plan, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. There is no copay for any services in this benefit, and coinsurance is at most 20% for Diagnostic and Therapeutic Radiological Services.
Home Health Services See details
Home Health Services are covered by the SCAN Classic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Both authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Classic (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $145.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture has a $10 copay and requires prior authorization, while OTC items are covered up to $90 every three months. Meal benefits also require prior authorization. Some services, such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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