A non-government entity
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 Riverside and San Bernardino 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 $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:
Sign up for SCAN Venture (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The SCAN Venture (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail-order pharmacies, while standard generic drugs have a $42 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The SCAN Venture (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital psychiatric services have a copay, while outpatient services have copays ranging from $25 to $225. Emergency services have a $90 copay, and ambulance services have a $155 copay. Primary care services have several copays, including $5 for chiropractic visits and $20 for mental health sessions. Preventive services are covered with no copay, and vision services include routine eye exams with no copay, and eyewear with a combined maximum plan benefit of $250 per year. Dental services have a wide range of copays depending on the service.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital Psychiatric services, there is a $125 copay for days 1-5, and no copay for days 6-90, while the plan does not cover additional days or non-Medicare-covered stays.
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 by the SCAN Venture (HMO) plan. Outpatient hospital services have a copay of $25-$225, while individual and group outpatient substance abuse sessions have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Venture (HMO) plan, with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance Services are covered by the SCAN Venture (HMO) plan, with a $155 copay for both ground and air ambulance services, and no coinsurance. 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 SCAN Venture (HMO). 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
Under the SCAN Venture (HMO) plan, 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 are covered. Chiropractic services and additional telehealth benefits require prior authorization and a doctor referral. Routine chiropractic care has a $5 copay for up to 24 visits per year. Occupational therapy services, physical therapy, and speech-language pathology services each have a $5 copay, while mental health and psychiatric individual and group sessions have a $20 copay. Opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, along with additional preventive services, health education, personal emergency response systems, fitness benefits, remote access technologies, and support for caregivers of enrollees. 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 and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services includes routine hearing exams, with 1 visit covered every year, and fitting/evaluation for hearing aids. Prescription Hearing Aids (all types) are covered, with a copay between $550 and $850 for 2 hearing aids every year; however, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The SCAN Venture (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum plan benefit of $250.00 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, but upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams with a copay of $10-$13, dental x-rays with a copay of $15, other diagnostic dental services with a copay of $0-$15, prophylaxis (cleaning) with a copay of $5, restorative services with a copay of $25-$500, adjunctive general services with a copay of $0-$65, endodontics with a copay of $25-$525, periodontics with a copay of $0-$375, prosthodontics (removable) with a copay of $30-$650, prosthodontics (fixed) with a copay of $45-$550, and oral and maxillofacial surgery with a copay of $0-$145. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with 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 under the SCAN Venture (HMO) plan, requiring prior authorization and a doctor referral. The copay for Dialysis Services is $25.
Medical Equipment See details
The SCAN Venture (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with 0% to 20% coinsurance, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items. Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay of at most $5.00, and Diagnostic Radiological Services with a copay of at most $75.00, and Therapeutic Radiological Services with a copay of at most $60.00, but Lab Services and Outpatient X-Ray Services are not covered. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the SCAN Venture (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the SCAN Venture (HMO) plan. This includes 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.
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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the SCAN Venture (HMO) plan, acupuncture is covered with a $5 copay, and a limit of 24 treatments per year, while over-the-counter items are covered up to $65 every three months. The plan also covers a meal benefit, and some services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services, are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved