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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 2025, 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 4.5 out of 5 stars in 2025.
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 $60.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy you use. For example, you'll pay no copay for preferred generic drugs at a preferred pharmacy, but a $15 copay at a standard pharmacy. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The SCAN Venture (HMO) plan offers a wide range of benefits with varying cost-sharing. The plan covers inpatient hospital stays with a copay for psychiatric services, outpatient services with copays, and partial hospitalization with a $55 copay. Emergency services and ambulance services have copays, while primary care, hearing, and vision services offer additional coverage. The plan also includes dental coverage with copays for different services, home infusion bundled services with copays or coinsurance, and dialysis services with a $25 copay. Other benefits include medical equipment with coinsurance, diagnostic and radiological services with copays, and home health services with no copay. Additionally, the plan covers cardiac rehabilitation services, skilled nursing facility stays with copays, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital services with the SCAN Venture (HMO) plan cover Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital Psychiatric, you will have a $125 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all 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 $25 and $225, and individual and group sessions for outpatient substance abuse have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Venture (HMO) plan, but requires prior authorization and a doctor's referral. There is a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Venture (HMO) plan. Ground and air ambulance services have a $155 copay, with no coinsurance, while 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 Venture (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $155 copay; Urgently Needed Services has no copay.
Primary Care See details
The SCAN Venture (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $5 copay for routine care, while individual and group sessions for mental health and psychiatric services have a $20 copay. Occupational therapy services, physical therapy and speech-language pathology services, and opioid treatment program services also have a $5 copay, and the additional telehealth benefits require a referral and prior authorization. Podiatry services are not covered.
Preventive Services See details
The SCAN Venture (HMO) plan covers preventive services including annual physical exams, health education, personal emergency response systems, fitness benefits, In-Home Support Services, Support for Caregivers of Enrollees, Remote Access Technologies, and other preventive services. The plan does not cover in-home safety assessments, 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 and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, or counseling services.
Hearing Services See details
The SCAN Venture (HMO) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $550 and $850, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The SCAN Venture (HMO) plan covers vision services including routine eye exams with no copay, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, all with a limit of one per year, and a combined maximum of $150 per year. Upgrades are not covered.
Dental Services See details
The SCAN Venture (HMO) plan covers Medicare Dental Services with a $5 copay, oral exams with a $10-$13 copay, and dental x-rays with a $15 copay limited to two per year. Other covered dental services include other diagnostic dental services with a $0-$15 copay, prophylaxis (cleaning) with a $5 copay limited to two visits per year, restorative services with a $25-$500 copay, adjunctive general services with a $0-$65 copay, endodontics with a $25-$525 copay, periodontics with a $0-$375 copay, prosthodontics (removable) with a $30-$650 copay, prosthodontics (fixed) with a $45-$550 copay, and oral and maxillofacial surgery with a $0-$145 copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. 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 by the SCAN Venture (HMO) plan, with a copay of $25.00. Prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetic Devices with a coinsurance of 0% to 20%, and Medical Supplies with a coinsurance of 0% to 20%. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay of $5, Diagnostic Radiological Services with a copay of at most $75, and Therapeutic Radiological Services with a copay of at least $60. Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Venture (HMO) plan 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 covered, but the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Venture (HMO) plan, with a $0 copay for days 1-20 and a $100 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The SCAN Venture (HMO) plan covers acupuncture with a $5 copay, and over-the-counter items up to $65 every three months, with nicotine replacement therapy and naloxone coverage. Meal benefits are also covered, with prior authorization required. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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