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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 Alameda and San Mateo Counties. 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 $1500.00 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 a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, but a $10 copay at standard pharmacies and standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you will pay $0 for Part D drugs.
Additional Benefits
The SCAN Classic (HMO) plan offers a range of benefits with varying cost-sharing structures. Inpatient hospital stays have copays, and outpatient services have copays that range from $0-$125. The plan also includes coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, and dental, with specific copays, coinsurance, and limitations on services. Additional benefits include home infusion services, dialysis services, medical equipment, and home health services, often requiring prior authorization and referrals. The plan also offers coverage for acupuncture, over-the-counter items, and a meal benefit. However, the plan does not cover cardiac rehabilitation services and excludes certain other services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the SCAN Classic (HMO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $100 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, ambulatory surgical center services, and outpatient substance abuse services, are covered under the SCAN Classic (HMO) plan. Outpatient hospital services have a copay between $0 and $125, and individual and group outpatient substance abuse sessions have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $180 copay. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year, but Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including 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, and Worldwide Emergency Transportation has a $180 copay, while Urgently Needed Services has no copay.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care physician services, chiropractic services (with prior authorization and referral), occupational therapy services (with prior authorization and referral, and no copay or coinsurance), physician specialist services (with prior authorization and referral), mental health specialty services (with a $10 copay for individual and group sessions), psychiatric services (with a $10 copay for individual and group sessions), physical therapy and speech-language pathology services (with prior authorization and referral, and no copay or coinsurance), additional telehealth benefits (with prior authorization and referral), and opioid treatment program services (with a $10 copay). Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Health Education, Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefit. In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 include coverage for hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are limited to one visit per year. Prescription hearing aids have a copay between $550 and $850, and are limited to two visits per year.
Vision Services See details
The SCAN Classic (HMO) plan covers vision services, including routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum plan benefit of $200 per year. Upgrades are not covered.
Dental Services See details
The SCAN Classic (HMO) plan covers various dental services, including oral exams and dental x-rays, with a limit of 2 visits per year for each. The plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics. Other preventive, restorative, endodontics, prosthodontics, and oral and maxillofacial surgery services are offered as an optional supplemental benefit; contact the plan for details.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Classic (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the SCAN Classic (HMO) plan. Durable Medical Equipment 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 coinsurance, and Diabetic Equipment is covered, however Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but some services are not covered. Therapeutic Radiological Services have a copay of at most $60.00, while Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Classic (HMO) plan with no copay and no coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the SCAN Classic (HMO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN Classic (HMO), 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 $75. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered with prior authorization, and you are limited to 36 treatments per year. The plan provides up to $75 every three months for OTC items, and the amount carries over if unused. The meal benefit is available following surgery or inpatient hospitalization, for a chronic illness, or for a medical condition that requires you to stay home for a period of time, with prior authorization. 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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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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