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SCAN Alta (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Alta (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Alta (HMO) in 2026, please refer to our full plan details page.
SCAN Alta (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that SCAN Alta (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 Alta (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 Alta (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 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 $500.00 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 Alta (HMO) Medicare Advantage plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $250. Once this deductible is met, you enter the initial coverage phase where you pay copays or coinsurance until your total drug costs reach $2,100. If you qualify for Extra Help, your Part D premium may be reduced to $0. Under this plan, Tier 1 preferred generic drugs have no copay when filled at preferred retail or mail-order pharmacies, while standard pharmacies charge a $15 copay. Tier 2 standard generics require a $42 copay at preferred pharmacies, whereas Tier 3 preferred brands and Tier 4 non-preferred drugs require 35% and 30% coinsurance respectively. After your yearly out-of-pocket drug costs reach $2,100, you enter catastrophic coverage and pay nothing for covered Part D prescriptions.
Additional Benefits
The SCAN Alta (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for inpatient hospital stays and no copay for most acute care days. Outpatient hospital visits, emergency care, and primary care services generally feature low copays ranging from no copay up to $90, with no coinsurance. Additionally, skilled nursing facility care is highly affordable, requiring no copay for the first 20 days of care. For daily wellness, the plan provides valuable supplemental benefits including dental care with no coinsurance, a $325 annual vision allowance, and hearing aid coverage with copays between $550 and $850. Members also benefit from up to 40 one-way transportation trips per year to approved locations and a $175 over-the-counter allowance every three months. Furthermore, Medicare-covered preventive care and urgent care are available with no copay and no coinsurance, while home health services are also fully covered.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by SCAN Alta (HMO) with no coinsurance, requiring doctor referrals and prior authorization. Acute care has no copay for days 1–3 and 8–90 and a $50 daily copay for days 4–7, while psychiatric care requires a $120 daily copay for days 1–5 and no copay for days 6–90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the SCAN Alta (HMO) plan, featuring a copay ranging from no copay up to $50 and no coinsurance for outpatient hospital visits. Outpatient substance abuse sessions require a $20 copay with no coinsurance, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by SCAN Alta (HMO) with a $55 copay and no coinsurance. Prior authorization is required for these services, and a doctor referral may also be necessary.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the SCAN Alta (HMO) plan, which features a $75 copay and no coinsurance for ground and air ambulance services requiring prior authorization. Transportation benefits are partially covered, offering up to 40 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Alta (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require no copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $90 for emergency coverage and $75 for emergency transportation.
Primary Care See details
Primary care benefits are partially covered by SCAN Alta (HMO), though podiatry services and individual or group mental health specialty sessions are not covered. Covered services like psychiatric and opioid treatment require a $20 copay and no coinsurance, while other services require prior authorization and referrals with no copays or coinsurance.
Preventive Services See details
SCAN Alta (HMO) partially covers preventive services with no copay and no coinsurance for Medicare-covered zero-dollar preventive care. Uncovered sub-services include medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, smoking cessation sessions, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Alta (HMO), offering hearing exams with no deductible and covered prescription hearing aids with a copay of $550 to $850 and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
SCAN Alta (HMO) partially covers vision services with no deductible, offering one routine eye exam per year and a $325 annual allowance for contacts and eyeglasses. Prior authorization and a doctor referral are required for these benefits, and eyewear upgrades are not covered.
Dental Services See details
SCAN Alta (HMO) partially covers dental services, offering no coinsurance and copayments ranging from no copay up to $395 depending on the service. Covered benefits include preventive care, restorative services, and oral surgery, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Alta (HMO) covers Home Infusion bundled services with prior authorization, featuring a $35 copay and coinsurance ranging from no coinsurance up to 20% for Medicare Part B insulin. Other covered Part B chemotherapy, radiation, and home infusion drugs require no copay and also carry coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
SCAN Alta (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access these covered services.
Medical Equipment See details
SCAN Alta (HMO) covers medical equipment with no copays and coinsurance ranging from 0% to 20%, depending on the service. While durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the SCAN Alta (HMO) plan, as diagnostic procedures/tests, lab services, diagnostic radiological services, and outpatient X-ray services are not covered. Covered therapeutic radiological services require no copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the SCAN Alta (HMO) plan, requiring prior authorization and a doctor referral before care can be received.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Alta (HMO) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by SCAN Alta (HMO) with no copay for days 1 to 20, a $50 daily copay for days 21 to 100, and no coinsurance. The benefit is partially covered as additional days beyond Medicare-covered services are not covered, and prior authorization and a doctor referral are required.
Other Services See details
Other Services are partially covered by SCAN Alta (HMO), featuring unlimited acupuncture and meal benefits following a hospitalization or for chronic illness (both requiring prior authorization), plus a $175 over-the-counter allowance every three months. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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