A non-government entity
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 2026, 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 out of 5 stars in 2026.
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.
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 $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:
Sign up for SCAN Balance (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The SCAN Balance (HMO C-SNP) plan offers an Enhanced Alternative prescription drug benefit with an annual drug deductible of $250.00. During the initial coverage phase, you will have no copay for Tier 1 preferred generic drugs filled at preferred retail or mail-order pharmacies, while standard pharmacies charge a $9.00 copay. Tier 2 standard generic drugs carry a $42.00 copay at preferred locations and a $47.00 copay at standard locations. For higher-tier medications, you will pay a coinsurance of 35% for Tier 3 preferred brands and 30% for Tier 4 non-preferred drugs. 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 drugs. Additionally, members who qualify for the low-income subsidy (LIS) will see their Part D costs reduced to $0.00.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers robust medical coverage with no copay for preventive care, urgent care, and outpatient hospital services. Members can expect predictable, low cost-sharing, such as a $10 copay for outpatient substance abuse and partial hospitalization, a $25 copay for dialysis, and a $90 copay for emergency room visits. Additionally, the plan covers emergency ambulance services with a $100 copay and includes up to 34 one-way trips per year to plan-approved health locations. For extra wellness benefits, the plan provides routine dental, vision, and hearing services with no copay for annual exams, plus a $350 yearly eyewear allowance and prescription hearing aid coverage. Members also enjoy a $65 monthly over-the-counter allowance, a $5 copay for acupuncture up to 30 times a year, and meal benefits with no copay. Home health services are covered, and dental copays range from no copay up to $395 depending on the service.
Inpatient Hospital See details
SCAN Balance (HMO C-SNP) partially covers inpatient hospital acute and psychiatric services, which require prior authorization and a doctor referral. Specific copay and coinsurance costs are not provided, but there is no cost sharing on the day of discharge, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN Balance (HMO C-SNP) with no copay or coinsurance for outpatient hospital, ambulatory surgical, and blood services. Outpatient substance abuse individual and group sessions are covered with a $10 copay and no coinsurance, and prior authorization and doctor referrals are required for most services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by SCAN Balance (HMO C-SNP) with a $10 copay and no coinsurance. These services require prior authorization and a doctor referral.
Ambulance and Transportation Services See details
SCAN Balance (HMO C-SNP) covers ground and air ambulance services with a $100 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, offering up to 34 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 under SCAN Balance (HMO C-SNP) with a $90 copay, which is waived if you are admitted, and no coinsurance. Urgently needed services have no copay and no coinsurance, while worldwide emergency services feature a $90 copay for emergency care and a $100 copay for emergency transportation with no coinsurance.
Primary Care See details
Primary Care benefits are covered by SCAN Balance (HMO C-SNP) with no coinsurance, featuring a $5 copay for routine chiropractic care and a $10 copay for opioid treatment, while podiatry is not covered. For both mental health specialty and psychiatric services, some services are covered, but individual and group sessions are not covered.
Preventive Services See details
Preventive services are partially covered by SCAN Balance (HMO C-SNP), featuring Medicare-covered preventive services with no copay and no coinsurance. While annual physicals, health education, and in-home safety assessments are included, the plan does not cover medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, bathroom safety devices, counseling, and additional smoking cessation sessions.
Hearing Services See details
Hearing Services are partially covered by SCAN Balance (HMO C-SNP), which offers covered routine hearing exams and fitting evaluations with no copay, no deductible, and no coinsurance. Prescription hearing aids (all types) are covered up to twice a year with a copay ranging from $450 to $750 and no coinsurance, while OTC hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
SCAN Balance (HMO C-SNP) partially covers vision services with no deductibles, offering coverage for one annual routine eye exam and up to $350 yearly for eyewear, though upgrades are not covered and specific copay or coinsurance details are not specified.
Dental Services See details
SCAN Balance (HMO C-SNP) partially covers dental services, as maxillofacial prosthetics, implant services, and orthodontics are not covered. Covered services require no coinsurance, with copays ranging from no copay up to $395.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN Balance (HMO C-SNP) with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Balance (HMO C-SNP) with a $25 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 Balance (HMO C-SNP), which covers Durable Medical Equipment (DME) with prior authorization. While some prosthetic, medical, and diabetic equipment services are technically covered, the plan does not cover prosthetic devices, medical supplies, diabetic supplies, or diabetic therapeutic shoes and inserts in practice.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Balance (HMO C-SNP), with covered therapeutic radiological services requiring a $50 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 Balance (HMO C-SNP), requiring both a doctor referral and prior authorization. There is no copay or coinsurance specified for these covered services under the plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Balance (HMO C-SNP) plan, meaning there is no coverage, copay, or coinsurance for these benefits. This exclusion applies to all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Balance (HMO C-SNP), as prior authorization and a doctor referral are required, though a prior three-day inpatient hospital stay is not. Standard SNF days are covered, but additional days beyond the Medicare-covered limit are not covered, and specific copay and coinsurance cost details are not specified.
Other Services See details
SCAN Balance (HMO C-SNP) partially covers other services, excluding Dual Eligible SNPs with Highly Integrated Services. Members pay a $5 copay and no coinsurance for up to 30 acupuncture treatments per year, and receive a $65 monthly over-the-counter allowance and a meal benefit with no copays or coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved