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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 Orange 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 features an Enhanced Alternative drug benefit with a $250 annual prescription drug deductible. During the initial coverage phase, there is no copay for Tier 1 preferred generic drugs when using preferred retail or preferred mail-order pharmacies. For Tier 2 standard generic drugs, the cost is a $42 copay at preferred pharmacies and a $47 copay at standard pharmacies. For Tier 3 preferred brand drugs, you will pay a 35% coinsurance, while Tier 4 non-preferred drugs require a 30% coinsurance. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs.
Additional Benefits
The SCAN Classic (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copays for annual preventive exams, urgent care, and routine vision or hearing evaluations. For emergency room visits, members pay a $90 copay which is waived upon hospital admission, while outpatient substance abuse and partial hospitalization require a low $10 copay. Primary care benefits feature no coinsurance, including acupuncture and routine chiropractic care for a $5 copay per visit. Additional benefits include dental care with copays ranging from no copay up to $395, and a $250 annual allowance for glasses or contacts with no deductible. Members also benefit from a $150 quarterly over-the-counter allowance, up to 32 one-way routine transportation trips with no copay, and prescription hearing aids available with a copay between $450 and $750. Ground and air ambulance services are covered with a $100 copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by SCAN Classic (HMO), requiring prior authorization and a doctor referral for acute and psychiatric stays. Unlimited additional acute days are covered, but upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered; specific copay and coinsurance costs are not specified, though there is no cost-sharing on the day of discharge.
Outpatient Services See details
Outpatient services are covered under the SCAN Classic (HMO) plan, including outpatient hospital, observation, ambulatory surgical center, and blood services, which require prior authorization and a doctor referral. Outpatient substance abuse individual and group sessions are covered with a $10 copay and no coinsurance, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by SCAN Classic (HMO) with a $10.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
SCAN Classic (HMO) partially covers ambulance and transportation services, as transportation to any health-related location is not covered. Ground and air ambulance services carry a $100 copay and no coinsurance, while up to 32 annual one-way trips to plan-approved locations are offered with no copay or coinsurance.
Emergency Services See details
SCAN Classic (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services are covered with no copay and no coinsurance, and worldwide emergency and transportation services are available with copays up to $100 and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered under SCAN Classic (HMO) with no coinsurance, featuring a $5 copay for routine chiropractic care (up to 30 visits per year) and a $10 copay for opioid treatment services. Podiatry, psychiatric services, and mental health specialty services are not covered under this plan.
Preventive Services See details
Preventive services are covered by SCAN Classic (HMO) with no copay or coinsurance for annual exams, kidney disease education, and Medicare-covered zero-dollar services. While some additional preventive benefits are covered, several sub-services are not, including 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/dietary benefits, home-based palliative care, additional smoking cessation sessions, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
SCAN Classic (HMO) partially covers hearing services, offering routine exams and fitting evaluations with no deductible and no coinsurance, as well as prescription hearing aids for a $450 to $750 copay and no coinsurance. OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by SCAN Classic (HMO) with no deductible, requiring prior authorization and a doctor referral for eye exams and eyewear. The plan covers one annual routine eye exam and provides a $250 yearly combined limit for glasses or contacts, though upgrades are not covered.
Dental Services See details
SCAN Classic (HMO) offers partially covered dental services with copays ranging from no copay up to $395 and no coinsurance. Specific services such as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SCAN Classic (HMO) with prior authorization, featuring no copay and no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
SCAN Classic (HMO) covers Dialysis Services with a $25 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
SCAN Classic (HMO) covers Durable Medical Equipment with prior authorization required. For prosthetics, medical supplies, and diabetic equipment, some services are covered, but prosthetic devices, medical supplies, diabetic supplies, and therapeutic shoes or inserts are not covered in practice.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Classic (HMO) and require prior authorization and a doctor referral. Therapeutic radiological services require a $50 copay and no coinsurance, and while some diagnostic services are covered with no copay and no coinsurance, diagnostic procedures, 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), requiring prior authorization and a doctor referral. No copay or coinsurance amounts are specified in the plan details for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Classic (HMO) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered in practice.
Skilled Nursing Facility (SNF) See details
SCAN Classic (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and a doctor referral but allowing admission without a prior three-day inpatient hospital stay. While standard Medicare-covered SNF days are provided, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SCAN Classic (HMO) covers acupuncture with a $5 copay and no coinsurance for up to 30 treatments per year. The plan also provides a $150 quarterly allowance for over-the-counter items and covers meal benefits immediately following a surgery or hospitalization.
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