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SCAN Balance (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Balance (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Balance (HMO C-SNP) in 2025, please refer to our full plan details page.
SCAN Balance (HMO C-SNP) is a HMO C-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in Los Angeles and Orange Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN Balance (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
SCAN Balance (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about SCAN Balance (HMO C-SNP).
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 Balance (HMO C-SNP), 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 $6.50. 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 $199.00 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 Balance (HMO C-SNP) 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 the pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies and mail order, and a $9 copay at standard pharmacies. For standard generic drugs, the copay is $42 at preferred pharmacies and mail order, and $47 at standard pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers a variety of benefits, including coverage for inpatient and outpatient services, with copays ranging from $0 to $100 depending on the service. The plan also covers primary care, preventive services, hearing, vision, and dental services, with specific copays and coverage limits for each. Additional benefits include ambulance and transportation services, emergency services, home health, home infusion, and dialysis services, along with coverage for medical equipment, and over-the-counter items. However, some services like certain dental procedures, hearing aids, and specific types of medical equipment are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, though Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute is covered with no limits.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered with a copay of $10 for both individual and group sessions for outpatient substance abuse. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN Balance (HMO C-SNP) with a $10 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $100 copay for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered for up to 34 one-way trips per year, but 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, while Worldwide Emergency Transportation has a $100 copay; there is no coinsurance for any of these services.
Primary Care See details
SCAN Balance (HMO C-SNP) covers Primary Care Physician Services, Chiropractic Services with a $5 copay for routine care, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services with a $10 copay. Individual and Group Sessions for Mental Health Specialty Services, 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 by the SCAN Balance (HMO C-SNP) plan. Additional services like Health Education, In-Home Safety Assessment, Personal Emergency Response System, Fitness Benefit, Remote Access Technologies, In-Home Support Services, and Support for Caregivers of Enrollees are covered. However, 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 Benefit, Home-Based Palliative Care, 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 with the SCAN Balance (HMO C-SNP) plan include routine hearing exams (1 per year) and fitting/evaluation for hearing aids, as well as prescription hearing aids (all types) covered with a copay between $450 and $750 for 2 visits per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including routine eye exams, eyewear, and contact lenses. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $350 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each covered once per year.
Dental Services See details
The SCAN Balance (HMO C-SNP) plan covers a range of dental services 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 between $0 and $5, other preventive dental services have a copay between $0 and $80, restorative services have a copay between $8 and $395, adjunctive general services have a copay between $0 and $125, endodontics have a copay between $5 and $395, periodontics have a copay between $0 and $380, prosthodontics (removable) have a copay between $13 and $395, prosthodontics (fixed) have a copay between $25 and $395, and oral and maxillofacial surgery has a copay between $0 and $140. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the SCAN Balance (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The copay for dialysis services ranges from a minimum to maximum of $25.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, both with no copay or coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment benefits are covered but limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the SCAN Balance (HMO C-SNP) plan. While there is no copay for diagnostic services, diagnostic procedures, tests, and lab services are not covered. Therapeutic Radiological Services have a copay of at most $50.00, but diagnostic radiological services and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Balance (HMO C-SNP) plan with no copay and no coinsurance, but require prior authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The SCAN Balance (HMO C-SNP) plan covers acupuncture with a $5 copay, up to 30 treatments per year, and also covers over-the-counter (OTC) items up to $125 every three months, with the ability to carry over unused amounts. The plan also covers a meal benefit, and some other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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