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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 Francisco 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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2400.00 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 an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you will pay varying copays and coinsurance amounts depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The SCAN Classic (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $150 copay for the first week, then no copay, while emergency services have a $90 copay. The plan also covers outpatient services, primary care, preventive services, hearing, vision, and dental services, each with specific copays or cost-sharing arrangements. Other benefits include ambulance services with a $175 copay, transportation services, and home health services with no copay. The plan also covers home infusion, dialysis, and medical equipment with coinsurance costs. However, some services like certain hearing aids, dental procedures, and home safety modifications are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a $150 copay for days 1-7, and no copay for days 8-90, as well as coverage for Inpatient Hospital Psychiatric with a $900 copay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital services have a copay between $0 and $200, while ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $10.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $25 copay, but prior authorization and a doctor's referral are required.
Ambulance and Transportation Services See details
The SCAN Classic (HMO) plan covers ambulance services with a $175 copay for both ground and air ambulance services, with no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, utilizing rideshare services, bus/subway, or medical transport. 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, while Worldwide Emergency Transportation has a $175 copay; all other services have no copay.
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, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Individual and Group Sessions for Mental Health and Psychiatric Services have a $10 copay, and Physical Therapy and Speech-Language Pathology Services have a $15 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Annual Physical Exams, Health Education, Personal Emergency Response Systems, Support for Caregivers of Enrollees, Fitness Benefits, and Remote Access Technologies. In-Home Safety Assessments, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, Home-Based Palliative Care, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams, routine hearing exams, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $550 and $850, but prescription hearing aids for the inner, outer, and over-the-ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams, with one visit covered every year, and for eyewear, including contact lenses, eyeglasses, and eyeglass lenses and frames, with a combined maximum benefit of $300 every two years; however, upgrades are not covered. Prior authorization and a doctor referral are required for all services.
Dental Services See details
The SCAN Classic (HMO) plan covers various dental services, including oral exams and dental x-rays with 2 visits per year, and other diagnostic dental services, prophylaxis (cleaning) with 2 visits per year, and other preventive dental services. Fluoride treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Restorative Services, Endodontics, Prosthodontics, removable, Prosthodontics, fixed, and Oral and Maxillofacial Surgery are offered as optional, supplemental benefits; contact the plan for details.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance of 0-20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the SCAN Classic (HMO) plan. Durable Medical Equipment (DME) has no copay, and a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and are subject to a coinsurance, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by SCAN Classic (HMO). Diagnostic procedures and lab services are not covered. Diagnostic Radiological Services have a copay of up to $60.00, and Therapeutic Radiological Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered under the SCAN Classic (HMO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the SCAN Classic (HMO) plan, but no copay or coinsurance information is available. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under 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 $125 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture and a meal benefit, with prior authorization required for both. Over-the-counter items, 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 are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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