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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 Riverside 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. Additionally, this plan comes with a Part B Premium reduction of $24.00. You must continue to pay paying your reduced 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 $399.00 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 will pay different copays or coinsurance amounts based on the drug tier and pharmacy type. 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 covered Part D drugs. However, the plan's formulary should be checked for specific drug coverage details.
Additional Benefits
The SCAN Classic (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays are covered, as are outpatient services, with copays for some services like substance abuse and outpatient hospital services. Emergency services have a $90 copay, and ambulance services have a $200 copay. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental, each with different copays or limits. Hearing services cover hearing exams and hearing aids with copays, while vision services include routine eye exams and eyewear up to a yearly limit. Dental services have copays depending on the service. Other benefits include home infusion, dialysis, medical equipment, home health services, skilled nursing facility, and additional services such as acupuncture and OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days for Inpatient Hospital-Acute are covered with no limit, while Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $50, and outpatient substance abuse services with a $10 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the SCAN Classic (HMO) plan. This benefit requires prior authorization and a doctor referral, and has a $10 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by SCAN Classic (HMO), including both ground and air ambulance services with a $200 copay. Transportation Services to a plan-approved health-related location are covered for up to 32 one-way trips per year, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the SCAN Classic (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay and no coinsurance, while Worldwide Emergency Transportation has a $200 copay and no coinsurance. Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health specialty services have a $10 copay, and opioid treatment program services also have a $10 copay. Routine Chiropractic Care is limited to 30 visits per year. Physical Therapy and Speech-Language Pathology Services, and Occupational Therapy Services have no copay or coinsurance. Individual and group sessions for psychiatric services, and podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Other covered services include health education, personal emergency response systems, in-home support services, support for caregivers of enrollees, fitness benefits, and remote access technologies, though some services such as in-home safety assessments, medical nutrition therapy, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with 1 visit every year, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $550 and $850 for 2 visits every year, but inner ear, outer ear, and over the ear prescription 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, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $200 per year. Upgrades are not covered.
Dental Services See details
Dental services include coverage for 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, with copays ranging from $0 to $395. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Classic (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the SCAN Classic (HMO) plan, and require prior authorization and a doctor's referral. The copay for Dialysis Services is $30.
Medical Equipment See details
Medical Equipment benefits are covered by SCAN Classic (HMO), including Durable Medical Equipment and Prosthetics/Medical Supplies, with no copay or coinsurance; however, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Prior authorization is required for Diabetic Equipment.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a copay of at most $25.00.
Home Health Services See details
Home Health Services are covered by the SCAN Classic (HMO) plan with no copay and no coinsurance, but require authorization and referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
SCAN Classic (HMO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor's referral are required for any covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $30.
Other Services See details
Under "Other Services," SCAN Classic (HMO) covers acupuncture with a limit of 30 treatments per year, and Over-the-Counter (OTC) items up to $150 every three months, including Nicotine Replacement Therapy and Naloxone. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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