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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 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 Los Angeles 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 $199.00 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 offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $250.00. Once this deductible is met, you will have no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, while standard locations charge a $15.00 copay. For Tier 2 standard generics, you will pay a $42.00 copay at preferred pharmacies and a $47.00 copay at standard pharmacies. For brand-name and non-preferred medications, Tier 3 preferred brands require 35% coinsurance and Tier 4 non-preferred drugs require 30% coinsurance across all pharmacy channels. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy can see their Part D premium reduced to $0.00.
Additional Benefits
The SCAN Classic (HMO) plan offers comprehensive coverage with predictable, low out-of-pocket costs for many essential medical services. Members pay no copay and no coinsurance for urgent care, routine preventive services, and over-the-counter items. Emergency services require a $90 copay, while outpatient sessions and dialysis feature low copays of $10 and $25 with no coinsurance. For routine wellness, the plan includes a $300 annual eyewear allowance with no deductible, and dental services are covered with no coinsurance and copays starting at no copay. Hearing exams also feature no deductible or coinsurance, while prescription hearing aids require a copay between $450 and $750. Additionally, the plan provides up to 32 one-way transportation trips per year to plan-approved locations.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by SCAN Classic (HMO) with no cost-sharing on the day of discharge, though specific copay and coinsurance details are not provided. While acute and psychiatric stays are covered with prior authorization, upgrades and non-Medicare-covered stays for acute care, along with additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
SCAN Classic (HMO) covers outpatient services, including outpatient hospital, ambulatory surgical center, and blood services, which require prior authorization and a doctor referral. Outpatient substance abuse sessions are covered with a $10 copay and no coinsurance, and outpatient blood services have no deductible.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization benefits with a $10.00 copay and no coinsurance. These covered services require prior authorization and, in some cases, a doctor referral.
Ambulance and Transportation Services See details
SCAN Classic (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance. Transportation services are partially covered, offering up to 32 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 and no coinsurance, while urgently needed services are provided with no copay and no coinsurance. Worldwide emergency and urgent care are also covered, featuring a $90 copay for emergency care, a $200 copay for emergency transportation, and no coinsurance.
Primary Care See details
SCAN Classic (HMO) offers partially covered primary care benefits, though podiatry services are not covered. Routine chiropractic care is available with a $5 copay and opioid treatment has a $10 copay, with no coinsurance for either service. For mental health specialty and psychiatric services, some services are covered but individual and group sessions are not.
Preventive Services See details
Preventive Services are partially covered by SCAN Classic (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, though prior authorization and referrals are required for certain benefits. Excluded sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Classic (HMO), which features no deductible or coinsurance for exams and fitting evaluations. Covered prescription hearing aids require a copay between $450 and $750 with no coinsurance, while OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by SCAN Classic (HMO) with no deductible, although specific copay and coinsurance details are not specified. The plan covers one annual routine eye exam and provides a $300 yearly eyewear allowance, but eyewear upgrades are not covered.
Dental Services See details
SCAN Classic (HMO) offers partially covered dental services with no coinsurance and copays ranging from no copay up to $395 depending on the service. While preventive care and various restorative treatments are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Classic (HMO) covers home infusion bundled services, including chemotherapy and other Part B drugs with no copay and ranging from no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance to 20% coinsurance, with prior authorization required for all home infusion services.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan with a $25 copay and no coinsurance. 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), which covers Durable Medical Equipment (DME) subject to prior authorization. Although some services are covered, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under SCAN Classic (HMO) are partially covered, with only therapeutic radiological services covered for a $50 copay and no coinsurance. All other sub-services, including diagnostic procedures and tests, lab services, diagnostic radiological services, and outpatient X-ray services, are not covered.
Home Health Services See details
Home health services are covered by SCAN Classic (HMO), but you will need a doctor referral and prior authorization to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Classic (HMO) plan, as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Classic (HMO), requiring prior authorization and a doctor referral, but additional days beyond Medicare-covered care are not covered. The plan allows SNF admission without a prior three-day inpatient hospital stay, though specific copay and coinsurance details are not specified.
Other Services See details
Other Services are partially covered by SCAN Classic (HMO), featuring acupuncture with a $5 copay and no coinsurance, as well as over-the-counter items and meal benefits with no copays or coinsurance, while Dual Eligible SNPs with Highly Integrated Services are not covered.
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