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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 Los Angeles 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 $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 has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at a preferred pharmacy, while standard generic drugs have a $42 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The SCAN Classic (HMO) plan offers a range of benefits with varying cost-sharing. Many services, such as primary care, preventive services, home health, and medical equipment, come with no copay. However, some services, like outpatient substance abuse services and acupuncture, have copays. The plan covers several services, including inpatient and outpatient hospital services, emergency services, hearing, vision, and dental, with some limitations. Ambulance services have a $200 copay, while hearing aids can cost between $350 and $650. Additionally, the plan offers coverage for home infusion bundled services, dialysis, and skilled nursing facilities, but prior authorization and referrals may be required.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization and a doctor's referral required. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and the Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, ambulatory surgical center services, and outpatient blood services, are covered. Outpatient substance abuse services are covered with a copay of $10 for both individual and group sessions.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization services with a $10 copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, as well as transportation services to plan-approved health-related locations, with prior authorization required for all ambulance services. Ground and air ambulance services have a $200 copay, and transportation services to plan-approved health-related locations cover up to 32 one-way trips per year using rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the SCAN Classic (HMO) plan. Emergency Services have a $90 copay, while Worldwide Emergency Coverage has a $90 copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care has a $5 copay for up to 30 visits per year, while individual and group sessions for mental health and psychiatric services, and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered by the SCAN Classic (HMO) plan. Additional services like Health Education, Personal Emergency Response System, Fitness Benefit, Remote Access Technologies, In-Home Support Services, and Support for Caregivers of Enrollees are covered; other services like In-Home Safety Assessment, Medical Nutrition Therapy, and several others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids (all types) are covered up to two times per year with a copay between $350 and $650, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Routine eye exams are covered once per year, and eyewear has a combined maximum benefit of $325 per year; the plan does not cover upgrades.
Dental Services See details
Dental Services are covered under the SCAN Classic (HMO) plan, including Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered, and Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) are limited to 2 visits per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance may apply, with a minimum of 0% and a maximum of 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, and may have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan and require prior authorization and a doctor referral. The copay for Dialysis Services is $25.
Medical Equipment See details
Medical Equipment benefits are covered by SCAN Classic (HMO), including Durable Medical Equipment and Prosthetics/Medical Supplies, both with no copay and no coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment requires prior authorization.
Diagnostic and Radiological Services See details
The SCAN Classic (HMO) plan's Diagnostic and Radiological Services benefit covers therapeutic radiological services with a copay of at most $50; however, diagnostic procedures/tests, lab services, diagnostic radiological services, and outpatient X-Ray services are not covered. All services require prior authorization and a doctor referral.
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. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
SCAN Classic (HMO) does not cover Cardiac Rehabilitation Services. While the plan covers Cardiac Rehabilitation Services, it does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Classic (HMO) plan, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization and a doctor's referral are required.
Other Services See details
Under "Other Services," SCAN Classic (HMO) covers acupuncture with a $5 copay, and up to 30 treatments per year, as well as over-the-counter (OTC) items, including nicotine replacement therapy and naloxone, up to $150 every three months. Meal benefits are covered with prior authorization. Several other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others.
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