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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 San Francisco 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 $1499.00 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 prescription drug plan features an Enhanced Alternative benefit design with a $250 annual drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order, while standard pharmacies charge a $12 copay. For Tier 2 standard generics, you will pay a $42 copay at preferred locations and a $47 copay at standard locations. Tier 3 preferred brand drugs require a 35% coinsurance, and Tier 4 non-preferred drugs require a 30% coinsurance across all pharmacy types. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for your covered Medicare Part D prescriptions. This plan also offers a reduction down to $0 for qualifying low-income subsidy recipients.
Additional Benefits
The SCAN Classic (HMO) plan provides robust medical coverage featuring fixed copays and no deductibles for primary services. Inpatient hospital stays require a $150 daily copay for the first five days and no copay for days six through 90, while outpatient hospital visits have a $125 copay. Routine primary care therapy services feature a $15 copay, emergency room visits require a $90 copay, and urgent care visits are available with no copay. Beyond standard medical care, this plan offers valuable supplemental benefits to support your daily health. Members receive routine vision and hearing exams with no copay, a $300 biennial eyewear allowance, and up to 24 one-way transportation trips to approved locations each year. Additionally, the plan provides a $70 quarterly over-the-counter allowance and covers preventive dental services to help minimize your out-of-pocket healthcare expenses.
Inpatient Hospital See details
SCAN Classic (HMO) partially covers inpatient hospital benefits, requiring a doctor referral and prior authorization with no coinsurance. Covered acute stays cost a $150 copay per day for days 1 to 5 and no copay for days 6 to 90, while psychiatric stays require a $900 copay per stay, but upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
SCAN Classic (HMO) covers outpatient services with no coinsurance, featuring a $125 copay for outpatient hospital services and a $100 copay for ambulatory surgical center visits. Outpatient substance abuse services require a $10 copay per session, while outpatient blood services are covered with no copay or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by SCAN Classic (HMO) with a $25.00 copay and no coinsurance. This benefit requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
SCAN Classic (HMO) covers ground and air ambulance services with a $175 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by SCAN Classic (HMO) with a $90 copay and no coinsurance, with the copay waived upon hospital admission. Urgently needed services require no copay and no coinsurance, while worldwide emergency care and transportation are covered with copays of $90 and $175 respectively, and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered under SCAN Classic (HMO), which excludes podiatry services. Most covered services, including physical, occupational, and speech therapies, feature a $15 copay and no coinsurance, while mental health, psychiatric, and opioid treatment services require a $10 copay and no coinsurance.
Preventive Services See details
Preventive services are covered by SCAN Classic (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, though prior authorization and referrals may be required. Additional preventive benefits are only partially covered; excluded services 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/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home/bathroom safety, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Classic (HMO), with covered routine exams and fitting evaluations requiring no copay, no coinsurance, and no deductible. Covered prescription hearing aids (all types) require a copay of $550 to $850 and no coinsurance, while OTC hearing aids and 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), offering one routine eye exam annually and a $300 combined eyewear allowance every two years with no deductibles, though upgrades are not covered. Prior authorization and doctor referrals are required for exams and eyewear.
Dental Services See details
Dental services are partially covered by SCAN Classic (HMO), as orthodontics is not covered. The plan covers preventive care, Medicare dental, and various comprehensive treatments, with a $3,000 annual limit on orthodontic services and prior authorization required for most procedures.
Home Infusion bundled Services See details
SCAN Classic (HMO) covers Home Infusion bundled Services with prior authorization and step therapy requirements. Medicare Part B insulin drugs require 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 no copay and a 20% 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), as diabetic supplies and diabetic therapeutic shoes/inserts are not covered. Covered services, including durable medical equipment, prosthetics, and medical supplies, require no copay and carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
SCAN Classic (HMO) partially covers diagnostic and radiological services, featuring diagnostic radiological services with a $50 copay and no coinsurance, and therapeutic radiological services with a 20% coinsurance and no copay. Diagnostic procedures, lab 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 specified for this benefit.
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, meaning there is no copay or coinsurance required for these services.
Skilled Nursing Facility (SNF) See details
SCAN Classic (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring a doctor referral and prior authorization. Patients pay no copay or coinsurance for days 1 to 20, and a $125 daily copay with no coinsurance for days 21 to 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN Classic (HMO), providing up to 20 acupuncture visits per year, post-hospitalization meal benefits, and a $70 quarterly over-the-counter allowance that carries forward, while Dual Eligible SNP services are not covered. Prior authorization is required for acupuncture and meals, and specific copay or coinsurance costs are not provided in the plan details.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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