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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 Riverside and San Bernardino 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 $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 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 $1900.00 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 offers an enhanced alternative drug benefit with an annual prescription drug deductible of $250. During the initial coverage phase, you will have no copay for Tier 1 preferred generic drugs at preferred pharmacies and preferred mail order, while standard options require a $15 copay. For Tier 2 standard generic drugs, the copay is $42 at preferred pharmacies and $47 at standard pharmacies. For higher-tier medications, Tier 3 preferred brands require 35% coinsurance and Tier 4 non-preferred drugs require 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy can reduce their Part D premium to $0.
Additional Benefits
The SCAN Venture (HMO) plan offers comprehensive coverage with low out-of-pocket costs, featuring no deductibles for many services and zero coinsurance for most primary care, emergency, and outpatient services. Under this plan, members enjoy no copay for urgent care, preventive services, and the first 20 days of skilled nursing facility stays. For inpatient psychiatric care, there is a $125 daily copay for the first five days and no copay for days six through 90. Specialty benefits include dental care with copays ranging from no copay up to $395, and vision care that includes a routine exam and a $250 annual eyewear allowance. Members also benefit from a $110 quarterly over-the-counter allowance, no-copay post-hospitalization meals, and up to 28 one-way trips to approved locations per year. Prescription hearing aids are available with copays between $550 and $850, while routine hearing exams have no deductible.
Inpatient Hospital See details
SCAN Venture (HMO) offers partially covered inpatient hospital benefits, with inpatient acute care covered but upgrades and non-Medicare-covered stays excluded. Inpatient psychiatric care is covered with no coinsurance and requires a $125 daily copay for days 1 through 5 and no copay for days 6 through 90, though additional psychiatric days and non-Medicare-covered psychiatric stays are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN Venture (HMO) with no coinsurance, featuring copayments ranging from $25 to $225 for outpatient hospital services and $40 for outpatient substance abuse sessions. Most of these services require prior authorization and a doctor referral, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
SCAN Venture (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under the SCAN Venture (HMO) plan, as transportation to any health-related location is not covered. Ground and air ambulance services require a $155 copay and no coinsurance, while covered transportation to plan-approved locations is limited to 28 one-way trips per year.
Emergency Services See details
SCAN Venture (HMO) covers emergency services with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services are provided with no copay and no coinsurance, while worldwide emergency coverage and emergency transportation are covered with a $90 and $155 copay respectively, and no coinsurance.
Primary Care See details
SCAN Venture (HMO) partially covers Primary Care benefits, as podiatry services are not covered. Covered services require no coinsurance, with copays of $5 for occupational, physical, 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, including annual physical exams and Medicare-covered zero-dollar services with no copay or coinsurance. Additional preventive benefits are partially covered, offering services like health education and personal emergency response systems, while excluding others such as therapeutic massage, weight management, and in-home safety assessments.
Hearing Services See details
SCAN Venture (HMO) covers routine hearing exams and fitting evaluations with no deductible, though prior authorization and a doctor referral are required. Prescription hearing aids are partially covered with a copay ranging from $550 to $850 and no coinsurance for up to two devices per year, while OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by SCAN Venture (HMO), providing one routine eye exam and a $250 annual eyewear allowance with no deductible, though eyewear upgrades are not covered. Prior authorization and doctor referrals are required for these benefits, which feature no specified copays or coinsurance.
Dental Services See details
SCAN Venture (HMO) offers partially covered dental services with no coinsurance and copays ranging from no copay up to $395. While preventive care, exams, cleanings, and restorative services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Venture (HMO) covers home infusion bundled services with prior authorization, offering Medicare Part B chemotherapy, radiation, and other drugs with no copay and ranging from no coinsurance to 20% coinsurance. Covered Medicare Part B insulin drugs require a $35 copay and also range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Venture (HMO) plan with a $25 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment is partially covered by SCAN Venture (HMO) because diabetic supplies are not covered. Covered services require prior authorization and feature no copay, with coinsurance ranging from no coinsurance up to 20% depending on the equipment.
Diagnostic and Radiological Services See details
SCAN Venture (HMO) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization and doctor referrals. Covered services include diagnostic procedures and tests for a $5 copay, diagnostic radiological services ranging from no copay to a $75 copay, and therapeutic radiological services for a $60 copay, while lab services and outpatient x-ray services are not covered.
Home Health Services See details
SCAN Venture (HMO) covers Home Health Services, which require prior authorization and a doctor referral. Specific copay and coinsurance details are not specified, so please contact the plan to verify any out-of-pocket costs.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Venture (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
SCAN Venture (HMO) covers Skilled Nursing Facility (SNF) services with no copay for days 1 through 20 and a $100 daily copay for days 21 through 100, with no coinsurance required. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN Venture (HMO), featuring acupuncture for a $5 copay and no coinsurance, a post-hospitalization meal benefit with no copay or coinsurance, and a $110 quarterly over-the-counter item allowance with no copay or coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered by this plan.
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