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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 San Bernardino 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 $11.00. 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 either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $15 copay at standard pharmacies. For preferred brand drugs, you will pay 50% coinsurance, regardless of the pharmacy.
Additional Benefits
The SCAN Classic (HMO) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the specific service. Emergency services have a $90 copay, and ambulance services have a $200 copay. The plan also covers primary care, preventive services, hearing, vision, and dental services. Additional benefits include coverage for home infusion, dialysis, and medical equipment with no copays for certain services. The plan also covers skilled nursing facility services, acupuncture, over-the-counter items, and meal benefits. Some services require prior authorization and a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Prior authorization and a doctor referral are required for these services.
Outpatient Services See details
Outpatient Services, including hospital services, ambulatory surgical center services, substance abuse services, and blood services, are covered by the SCAN Classic (HMO) plan. Outpatient Hospital Services have a copay between $0 and $50, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Classic (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $10.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $200 copay. Transportation Services to a plan-approved health-related location are covered for 32 one-way trips per year. 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. Emergency Services and Worldwide Emergency Coverage have a $90 copay with no coinsurance, while Worldwide Emergency Transportation has a $200 copay with no coinsurance.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, 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. Chiropractic services require prior authorization and a doctor referral, and there is no maximum plan benefit coverage amount. Individual and group sessions for mental health specialty services have a $10 copay. Opioid Treatment Program Services also have a $10 copay. Occupational therapy, physical therapy, and speech-language pathology services have no copay or coinsurance, but require prior authorization and a doctor referral. Podiatry services and Individual and Group Sessions for Psychiatric Services are not covered.
Preventive Services See details
Preventive services, including health education, personal emergency response systems, fitness benefits, remote access technologies, in-home support services, and support for caregivers of enrollees, are covered. In-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing services with SCAN Classic (HMO) include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, with no deductible. Prescription hearing aids are covered, with a copay between $550 and $850 for all types, but inner, outer, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The SCAN Classic (HMO) plan covers vision services, including routine eye exams with no deductible. The plan also covers one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames per year. Eyewear has a combined maximum plan benefit of $200 per year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, 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. Other Diagnostic Dental Services have a copay of $0-$5, Other Preventive Dental Services have a copay of $0-$80, Restorative Services have a copay of $8-$395, Adjunctive General Services have a copay of $0-$125, Endodontics has a copay of $5-$395, Periodontics has a copay of $0-$380, Prosthodontics (removable) has a copay of $13-$395, Prosthodontics (fixed) has a copay of $25-$395, and Oral and Maxillofacial Surgery has a copay of $0-$140. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the SCAN Classic (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs with 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs also have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan, requiring prior authorization and a doctor's referral. The copay for Dialysis Services is $30.
Medical Equipment See details
Medical Equipment benefits under the SCAN Classic (HMO) plan include Durable Medical Equipment and Prosthetics/Medical Supplies, with no copay or coinsurance for either. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Classic (HMO). 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 or coinsurance. However, 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 these services.
Skilled Nursing Facility (SNF) See details
The SCAN Classic (HMO) plan covers Skilled Nursing Facility (SNF) services, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, there is a $30 copay.
Other Services See details
The SCAN Classic (HMO) plan covers acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture requires prior authorization, and OTC items have a maximum benefit coverage amount of $150 every three months. The meal benefit also requires prior authorization.
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