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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 Riverside 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 $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) Medicare Advantage plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $250.00. After meeting this deductible, members enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies and through preferred mail order, while standard pharmacies and standard mail cost $15.00. For Tier 2 standard generic drugs, you will pay a $42.00 copay at preferred locations or a $47.00 copay at standard locations. Tier 3 preferred brand drugs require a 35% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance across all pharmacy options. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The SCAN Classic (HMO) plan offers robust coverage with low out-of-pocket costs, featuring no copays or coinsurance for preventive services, annual physicals, and urgent care. Outpatient services require no coinsurance with copays ranging from no copay to $50, while emergency room visits carry a $90 copay that is waived if you are admitted. Standard medical care like primary care, dialysis, and skilled nursing facility stays for the first 20 days also feature no coinsurance and low or no copays. For specialty care, the plan provides dental coverage with copays up to $395 and no coinsurance, alongside a $300 annual allowance for eyewear with no deductible. Hearing services include exams and select prescription hearing aids with copays between $550 and $850, and transportation is covered for up to 36 one-way trips per year. Additionally, members can access acupuncture for a $5 copay, as well as over-the-counter items and home-delivered meals with no copay or coinsurance.
Inpatient Hospital See details
SCAN Classic (HMO) partially covers Inpatient Hospital benefits, although specific copay and coinsurance costs are not specified. While acute and psychiatric stays are covered, the plan excludes coverage for upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
SCAN Classic (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $50 for outpatient hospital services and a $10 copay for outpatient substance abuse sessions. Prior authorization and doctor referrals are required for most of these services, which also include ambulatory surgical center and outpatient blood services with no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by SCAN Classic (HMO) with a $10.00 copay and no coinsurance. Prior authorization and a doctor referral are required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by SCAN Classic (HMO), as transportation to any health-related location is not covered. Ground and air ambulance services require a $200 copay and no coinsurance, while plan-approved transportation is covered for up to 36 one-way trips per year.
Emergency Services See details
Emergency services are covered by SCAN Classic (HMO) with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services feature no copay and no coinsurance, while worldwide emergency services and emergency transportation are covered with no coinsurance and copays of $90 and $200, respectively.
Primary Care See details
Primary Care benefits are partially covered by SCAN Classic (HMO) with no coinsurance, as podiatry is not covered, and for psychiatric services, some services are covered but individual and group sessions are not. Routine chiropractic care is covered with a $5 copay, while mental health and opioid treatment services require a $10 copay.
Preventive Services See details
Preventive Services are partially covered by SCAN Classic (HMO), offering no copay and no coinsurance for Medicare-covered zero-dollar preventive services, annual physical exams, and kidney disease education. Sub-services that are not covered under this plan 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 benefits, palliative care, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Classic (HMO), offering routine exams, fitting evaluations, and select prescription hearing aids with a copay ranging from $550 to $850 and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and 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, though specific copay and coinsurance details are not specified. This plan covers one routine eye exam annually and provides a $300 yearly limit for eyewear, including contacts and glasses, but upgrades are not covered.
Dental Services See details
SCAN Classic (HMO) partially covers dental services with copays ranging from no copay to $395 and no coinsurance for covered benefits. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Classic (HMO) covers Home Infusion bundled Services with prior authorization and step therapy requirements. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Classic (HMO) with a $30 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical equipment is partially covered under SCAN Classic (HMO), which covers Durable Medical Equipment (DME) with prior authorization. However, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Classic (HMO), requiring prior authorization and a doctor referral. Therapeutic radiological services are covered with a $25 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. Specific copay and coinsurance details are not provided in this plan benefit summary.
Cardiac Rehabilitation Services See details
SCAN Classic (HMO) indicates that some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Because these services are not covered, there is no copay or coinsurance required.
Skilled Nursing Facility (SNF) See details
SCAN Classic (HMO) partially covers Skilled Nursing Facility (SNF) services, though additional days beyond the Medicare-covered limit are not covered. Patients pay no copay or coinsurance for days 1 through 20, and a $30 daily copay with no coinsurance for days 21 through 100, with prior authorization and a doctor referral required.
Other Services See details
Other Services covered by the SCAN Classic (HMO) plan include acupuncture, which requires a $5 copay and no coinsurance for up to 30 visits per year. Over-the-counter items and limited-duration meal benefits are also covered with no copay or coinsurance, while highly integrated services for dual-eligible SNPs are not covered.
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