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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 2025, 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 4.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a $42 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The SCAN Alta (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have copays depending on the length of stay, and outpatient services have copays between $0 and $50. Emergency services have a $90 copay, and primary care visits have copays that range from $5 to $20. This plan also includes coverage for hearing, vision, and dental services. Hearing exams and vision exams are available once per year, and eyewear is covered with a combined maximum benefit of $325 per year. Dental services include oral exams, x-rays, and other procedures, with copays varying based on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, there is no copay for days 1-3 and 8-90, and a $50 copay for days 4-7. For Inpatient Hospital Psychiatric, there is a $120 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $50, and individual and group outpatient substance abuse sessions have a copay of $20.
Partial Hospitalization See details
SCAN Alta (HMO) covers partial hospitalization with a $55 copay, but prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Alta (HMO) plan. Ground and air ambulance services have a $75 copay, and the plan also covers transportation services to plan-approved health-related locations, with up to 32 one-way trips per year via rideshare, bus/subway, or medical transport. 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 by the SCAN Alta (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, and Worldwide Emergency Transportation has a $75 copay, while Urgently Needed Services and Worldwide Urgent Coverage have no copay.
Primary Care See details
The SCAN Alta (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Routine Chiropractic Care has a $5 copay, and Individual and Group Sessions for Psychiatric Services and Opioid Treatment Program Services have a copay between $20 and $20.
Preventive Services See details
The SCAN Alta (HMO) plan covers preventive services, including annual physical exams, health education, in-home safety assessments, personal emergency response systems, fitness benefits, remote access technologies, support for caregivers of enrollees, and other preventive services. However, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
The SCAN Alta (HMO) plan covers hearing exams and fitting/evaluation for hearing aids, with routine hearing exams covered once per year. Prescription hearing aids are covered, with a copay between $550 and $850, depending on the type of aid. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with no deductible, and are available once per year. Eyewear is covered with a combined maximum benefit of $325 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, each with a limit of one per year. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery. Oral exams and dental x-rays are limited to 2 visits per year. Other diagnostic dental services have a copay of $0-$5, restorative services have a copay of $8-$395, adjunctive general services have a copay of $0-$125, endodontics have a copay of $5-$395, periodontics have a copay of $0-$380, prosthodontics, removable have a copay of $13-$395, prosthodontics, fixed have a copay of $25-$395, and oral and maxillofacial surgery have a copay of $0-$140. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Other preventive dental services have a copay of $0-$80.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the SCAN Alta (HMO) plan, but require prior authorization and a doctor referral. The coinsurance for these services is 20%.
Medical Equipment See details
The SCAN Alta (HMO) plan covers Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and no copay, though Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices are covered with a coinsurance between 0% and 20%, and no copay. Medical supplies are covered with a coinsurance between 0% and 20%, and no copay. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the SCAN Alta (HMO) plan, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by SCAN Alta (HMO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Alta (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $50 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The SCAN Alta (HMO) plan covers acupuncture with a $5 copay, over-the-counter items with a maximum benefit of $150 every three months, and a meal benefit. This plan does not cover Dual Eligible SNPs with Highly Integrated Services. Additional services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing, and others are not covered.
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