A non-government entity
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 2026, 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 San Diego County. This plan received an overall rating of 4 out of 5 stars in 2026.
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 a $250.00 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 $3400.00 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:
Sign up for SCAN Classic (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The SCAN Classic (HMO) Medicare plan features an annual prescription drug deductible of $250.00. During the initial coverage phase, Tier 1 preferred generic drugs require a $5.00 copay at preferred pharmacies or a $15.00 copay at standard pharmacies. Tier 2 standard generic drugs cost a $42.00 copay at preferred locations and a $47.00 copay at standard locations. For brand-name and non-preferred medications, you will pay 35% coinsurance for Tier 3 drugs and 30% coinsurance for Tier 4 drugs. Once your yearly out-of-pocket costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the Extra Help low-income subsidy will pay no premium for Part D.
Additional Benefits
The SCAN Classic (HMO) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copay for Medicare-covered preventive services and low copays ranging from $5 to $35 for primary and specialist care. For hospital stays, members pay a $275 daily copay for the first seven days of acute inpatient care and no copay for days 8 through 90. Emergency room visits carry a $90 copay, which is waived if you are admitted, while urgent care visits require a $30 copay, both with no coinsurance. This plan also includes valuable supplemental benefits such as routine vision exams with no copay to a $10 copay and up to $300 for eyewear every two years with a $10 copay. Dental care is available with no coinsurance and copays ranging from no copay up to $395, while routine hearing exams require a $10 copay. Additionally, members can access up to 40 one-way transportation trips to approved health locations and receive durable medical equipment with a 20% coinsurance and no copay.
Inpatient Hospital See details
SCAN Classic (HMO) partially covers inpatient hospital services with no coinsurance, charging a $275 daily copay for days 1-7 of acute stays and a $250 daily copay for days 1-7 of psychiatric stays, with no copay for days 8-90. Non-Medicare-covered stays, upgrades, and additional psychiatric stay days are not covered.
Outpatient Services See details
SCAN Classic (HMO) covers outpatient services with no coinsurance and copays ranging from $25 for outpatient substance abuse sessions to $35 for ambulatory surgical center services, and $35 to $300 for outpatient hospital services. There is no deductible for outpatient blood services, though prior authorization and doctor referrals are required for most covered benefits.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization benefits with a $25 copay and no coinsurance. Prior authorization and a doctor referral are required for these services.
Ambulance and Transportation Services See details
SCAN Classic (HMO) covers ground and air ambulance services with a $240 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 40 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Classic (HMO) covers emergency services with a $90 copay—waived if admitted to the hospital—and urgently needed services with a $30 copay, both with no coinsurance. Worldwide emergency care, urgent care, and emergency transportation are also covered with copays ranging from $30 to $240 and no coinsurance.
Primary Care See details
SCAN Classic (HMO) partially covers primary care benefits, with podiatry services not covered under the plan. Covered services, including primary care visits, specialist care, and therapy services, require copays ranging from $5 to $35 with no coinsurance.
Preventive Services See details
Preventive services are partially covered by SCAN Classic (HMO), which features no copay and no coinsurance for Medicare-covered zero-dollar preventive services. However, several sub-services are not covered, including in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, tobacco cessation counseling, disease management, telemonitoring, bathroom modifications, and counseling.
Hearing Services See details
SCAN Classic (HMO) provides partially covered hearing services, featuring routine exams for a $10 copay and no coinsurance, and up to two prescription hearing aids per year with a copay ranging from $550 to $850 and no coinsurance. OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
SCAN Classic (HMO) provides partially covered vision services, including one annual routine eye exam with no copay to a $10 copay and no coinsurance. Eyewear is covered up to a $300 limit every two years with a $10 copay and no coinsurance, but eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by SCAN Classic (HMO) with no coinsurance and copays ranging from no copay up to $395, though Medicare-covered dental services require a $10 copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered under SCAN Classic (HMO) with prior authorization, excluding Part D home infusion drugs. Covered chemotherapy, radiation, and other Part B drugs require no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Classic (HMO) with 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical Equipment benefits are partially covered by SCAN Classic (HMO) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Prior authorization is required for these covered services, while diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
SCAN Classic (HMO) partially covers Diagnostic and Radiological Services, though diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services require a $50 copay and no coinsurance, while therapeutic radiological services require a copay and up to 20% coinsurance, with both requiring doctor referrals and prior authorization.
Home Health Services See details
Home Health Services are covered by SCAN Classic (HMO), though patients must obtain a doctor referral and prior authorization to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are listed as having some services covered under the SCAN Classic (HMO) plan, but in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, meaning there is no copay or coinsurance.
Skilled Nursing Facility (SNF) See details
SCAN Classic (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $140 daily copay for days 21 through 100. Prior authorization and a doctor referral are required, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
SCAN Classic (HMO) partially covers other services, excluding Dual Eligible SNPs with Highly Integrated Services. Acupuncture is covered with a $5 copay and no coinsurance for up to 20 treatments per year, while over-the-counter items and post-hospitalization meal benefits are offered with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved