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SCAN Venture (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Venture (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Venture (HMO) in 2026, please refer to our full plan details page.
SCAN Venture (HMO) is a HMO 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 Venture (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 Venture (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 Venture (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. Additionally, this plan comes with a Part B Premium reduction of $55.00. You must continue to pay paying your reduced 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 $1000.00 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 Venture (HMO) prescription drug plan features an annual drug deductible of $250.00 before your initial coverage begins. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order service. For Tier 2 standard generic drugs, your cost is a $42.00 copay at preferred locations and a $47.00 copay at standard locations. For brand-name and non-preferred medications, Tier 3 drugs require a 35% coinsurance and Tier 4 drugs require a 30% coinsurance. Once your yearly out-of-pocket drug expenses reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. This structured tier system helps beneficiaries of the SCAN Venture (HMO) plan easily manage and predict their healthcare expenses.
Additional Benefits
SCAN Venture (HMO) offers affordable coverage for core medical services, featuring no coinsurance and no copay for urgent care and Medicare-covered preventive services. Emergency room visits require a $90 copay, which is waived if you are admitted, while outpatient hospital services carry a copay ranging from $25 to $225. Primary care therapy sessions and acupuncture are highly accessible with a low $5 copay and no coinsurance. Supplemental benefits include routine dental care with no coinsurance and copays ranging from no copay up to $395. Routine vision and hearing exams are available with no copay, and the plan provides a $150 annual eyewear allowance alongside a $550 to $850 copay for prescription hearing aids. Additionally, skilled nursing facility stays require no copay for the first 20 days, and over-the-counter items are covered with no copay.
Inpatient Hospital See details
Inpatient hospital benefits offered by SCAN Venture (HMO) cover acute and psychiatric stays, requiring prior authorization and doctor referrals. Psychiatric stays carry a $125 copay per day for days 1 through 5, no copay for days 6 through 90, and no coinsurance, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
SCAN Venture (HMO) covers outpatient services with no coinsurance, featuring a $25 to $225 copay for outpatient hospital services and a $40 copay for outpatient substance abuse sessions. Ambulatory surgical center, observation, and outpatient blood services are also covered.
Partial Hospitalization See details
SCAN Venture (HMO) covers partial hospitalization benefits with a $55 copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by SCAN Venture (HMO), featuring a $155 copay and no coinsurance for ground and air ambulance services. Transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
SCAN Venture (HMO) covers emergency services with a $90 copay (waived if admitted) and no coinsurance, and urgently needed services with no copay and no coinsurance. Worldwide emergency services and worldwide emergency transportation are also covered with copays of $90 and $155, respectively, and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by SCAN Venture (HMO), which excludes podiatry services. Covered care requires no coinsurance and features copays of $5 for occupational, physical, speech, and routine chiropractic therapies, $20 for mental health and psychiatric sessions, and $40 for opioid treatment.
Preventive Services See details
SCAN Venture (HMO) covers preventive services with no copay or coinsurance for Medicare-covered zero-dollar services, though some benefits require referrals or prior authorization. Additional preventive services are only partially covered, with sub-services such as in-home safety assessments, medical nutrition therapy, alternative therapies, therapeutic massage, and weight management programs excluded from coverage.
Hearing Services See details
Hearing services are partially covered by SCAN Venture (HMO), which offers routine hearing exams and fitting evaluations with no copay and no coinsurance. Covered prescription hearing aids require a copay of $550 to $850 with no coinsurance, but over-the-counter (OTC) hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services are partially covered by SCAN Venture (HMO), with upgrades not covered. Covered benefits include one routine eye exam annually and a $150 combined yearly allowance for eyewear with no deductible, though specific copay and coinsurance details are not specified.
Dental Services See details
Dental services are partially covered by SCAN Venture (HMO), with copays ranging from no copay up to $395 and no coinsurance. While many preventive and comprehensive treatments are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SCAN Venture (HMO) with prior authorization required. Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by SCAN Venture (HMO) 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 by SCAN Venture (HMO), as diabetic supplies are not covered. Other covered benefits, including durable medical equipment, prosthetics, and therapeutic shoes, require prior authorization and feature no copays with coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Venture (HMO) with no coinsurance, though lab services and outpatient x-ray services are not covered. Covered diagnostic procedures require a $5 copay, therapeutic radiological services require a $60 copay, and diagnostic radiological services range from no copay up to a $75 copay.
Home Health Services See details
Home Health Services are covered by SCAN Venture (HMO), requiring prior authorization and a doctor referral for members to access these benefits.
Cardiac Rehabilitation Services See details
SCAN Venture (HMO) covers some Cardiac Rehabilitation Services with varying copays and no coinsurance, though cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
SCAN Venture (HMO) partially covers Skilled Nursing Facility (SNF) services with no copay for days 1 to 20, a $100 daily copay for days 21 to 100, and no coinsurance. Prior authorization and a doctor referral are required, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN Venture (HMO), excluding Dual Eligible SNPs with Highly Integrated Services. Covered benefits include acupuncture with a $5 copay and no coinsurance, as well as over-the-counter items and limited meal benefits, both offered with no copay and no coinsurance.
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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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