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.

This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.

SCAN Classic (HMO) is a HMO plan offered by Scan Health Plan available for the 2026 plan year to people living in Santa Clara and Stanislaus Counties. 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.

Overview IconKey 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

Health deductible: information not available.

This plan has a $250.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.

Out-of-Pocket Maximums

This plan has a Maximum Out-Of-Pocket cost of $799.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $799.00 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:

Regular visits to your primary care doctor are covered and will have a coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care are covered and will have a coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for SCAN Classic (HMO)

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Drug Coverage IconDrug Coverage

The SCAN Classic (HMO) prescription drug plan features an annual drug deductible of $250.00 before coverage begins. Once this deductible is met, you will pay no copay for Tier 1 preferred generic drugs at preferred retail pharmacies or through preferred mail order, while standard generics carry a $42.00 copay. For higher-tier medications, you will pay a 35% coinsurance for preferred brands and a 30% coinsurance for non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Part D prescription drugs. Additionally, beneficiaries who qualify for the Low-Income Subsidy (Extra Help) can benefit from a reduced Part D premium of $0.00. This plan provides structured, predictable cost-sharing to help you manage your healthcare budget.

Additional Benefits IconAdditional Benefits

The SCAN Classic (HMO) plan offers comprehensive medical coverage featuring no copay for preventive services, annual physicals, and urgently needed care. Members benefit from low out-of-pocket costs, including a $5 copay for routine chiropractic care, a $10 copay for mental health sessions, and outpatient hospital services ranging from no copay up to $100. Emergency room visits require a $90 copay, which is waived upon hospital admission, while ground and air ambulance services carry a $95 copay. For supplemental care, the plan provides robust dental coverage up to a $3,000 annual limit and a $250 annual allowance for eyewear alongside routine vision exams. Additional perks include a $170 quarterly allowance for over-the-counter items, up to 40 one-way transportation trips to approved health locations, and meal benefits with no copay. Specialized care like skilled nursing facilities features no copay for the first 20 days, while prescription hearing aids are covered with copays ranging from $550 to $850.

Inpatient Hospital See details

SCAN Classic (HMO) partially covers inpatient hospital services, requiring prior authorization and doctor referrals. Inpatient psychiatric care has no coinsurance, featuring no copay for days 1 to 4 and 11 to 90, and a $75 copay for days 5 to 10, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.

Outpatient Services See details

Outpatient services are covered by SCAN Classic (HMO) with no coinsurance, featuring no copay to a $100 copay for outpatient hospital services and a $10 copay for outpatient substance abuse sessions. Prior authorization and doctor referrals are required for most of these covered benefits, which also include ambulatory surgical center and outpatient blood services with no deductible.

Partial Hospitalization See details

Partial hospitalization benefits are covered by SCAN Classic (HMO) with a $55.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.

Ambulance and Transportation Services See details

SCAN Classic (HMO) covers ground and air ambulance services with a $95 copay and no coinsurance. Transportation services are partially covered, offering up to 40 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

SCAN Classic (HMO) covers emergency services with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services are covered with no copay or coinsurance, while worldwide emergency and transportation services are covered with copays of $90 and $95, respectively, and no coinsurance.

Primary Care See details

SCAN Classic (HMO) partially covers Primary Care benefits, as podiatry services are not covered. Most covered services require no coinsurance, with copays of $5 for routine chiropractic care and $10 for mental health, psychiatric, and opioid treatment sessions.

Preventive Services See details

Preventive services are covered by SCAN Classic (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physical exams, and kidney disease education. Additional preventive benefits are partially covered, but in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.

Hearing Services See details

SCAN Classic (HMO) partially covers hearing services, including one routine hearing exam annually and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to two per year with a copay ranging from $550 to $850 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.

Vision Services See details

SCAN Classic (HMO) partially covers vision services with no deductibles, offering one routine eye exam per year and a $250 annual limit for eyewear like glasses and contacts, though upgrades are not covered. Prior authorization and referrals are required, and while specific copay and coinsurance details are not specified, there is no deductible for these benefits.

Dental Services See details

Dental services are partially covered by SCAN Classic (HMO), which includes preventive care and comprehensive treatments up to a $3,000 annual limit, though orthodontics is not covered. Specific copay and coinsurance costs are not specified in the plan details, and prior authorization is required for several comprehensive services.

Home Infusion bundled Services See details

SCAN Classic (HMO) covers Home Infusion bundled Services with prior authorization, including Part B insulin drugs for a $35 copay and no coinsurance to 20% coinsurance. Chemotherapy, radiation, and other Part B drugs are covered with no copay and no coinsurance to 20% coinsurance.

Dialysis Services See details

SCAN Classic (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to access this benefit.

Medical Equipment See details

SCAN Classic (HMO) partially covers medical equipment, offering durable medical equipment, prosthetic devices, and medical supplies with no copay and coinsurance ranging from no coinsurance to 20% with prior authorization. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered under this plan.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are partially covered by SCAN Classic (HMO), as diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services require no coinsurance and a copay ranging from no copay up to $100, while therapeutic radiological services require a 20% coinsurance and an applicable copay.

Home Health Services See details

Home Health Services are covered by SCAN Classic (HMO), but require prior authorization and a doctor referral. While these services are covered, specific copay and coinsurance cost-sharing details are not specified in the plan terms.

Cardiac Rehabilitation Services See details

SCAN Classic (HMO) does not cover Cardiac Rehabilitation Services, as all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage. Because these services are not covered, there are no copayments or coinsurance benefits provided.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Classic (HMO) with prior authorization and a doctor referral required, though additional days beyond Medicare-covered stays are not covered. There is no copay or coinsurance for days 1 to 20, and a $50 daily copay with no coinsurance for days 21 to 100.

Other Services See details

SCAN Classic (HMO) provides partial coverage for other services, as Dual Eligible SNPs with Highly Integrated Services are not covered. Covered benefits include unlimited acupuncture treatments for a $5 copay and no coinsurance, a $170 quarterly allowance for over-the-counter items, and meal benefits with no copay or coinsurance.

Plan Providers IconPlan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

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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.

* 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.

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