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SCAN Embrace (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Embrace (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Embrace (HMO I-SNP) in 2025, please refer to our full plan details page.
SCAN Embrace (HMO I-SNP) is a HMO I-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in Los Angeles County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN Embrace (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
SCAN Embrace (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about SCAN Embrace (HMO I-SNP).
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 Embrace (HMO I-SNP), 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 $70.00. 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 $799.00 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 Embrace (HMO I-SNP) plan has an enhanced alternative drug benefit. The plan has no deductible. During the initial coverage phase, you will pay no copay for preferred generic drugs. For standard generic drugs, the copay is $42.00-$43.00 depending on the pharmacy, and for preferred brand drugs you will pay 50% coinsurance.
Additional Benefits
The SCAN Embrace (HMO I-SNP) plan offers a wide range of benefits with varying costs. Many services have no copay, including primary care, preventive services, home health, and dialysis. This plan also covers emergency services, ambulance and transportation, and offers vision, hearing, and dental benefits, each with their own copays and annual limits. This plan also includes coverage for medical equipment, home infusion, and skilled nursing facilities, along with coverage for other services like over-the-counter items. However, it is important to note that some services may require prior authorization or referrals, and certain services, such as some outpatient services, are not fully covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by the SCAN Embrace (HMO I-SNP) plan. The plan covers partial hospitalization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Embrace (HMO I-SNP) plan. Ground and air ambulance services have a copay of $95, and transportation services to a plan-approved health-related location are covered for up to 28 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the SCAN Embrace (HMO I-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $95 copay, and Worldwide Urgent Coverage has no copay.
Primary Care See details
Primary care physician services, occupational therapy services, physical therapy, and speech-language pathology services are covered with no copay and no coinsurance, but authorization and a referral may be required. Chiropractic services, mental health specialty services, and psychiatric services do not cover all sub-services. Podiatry services and additional telehealth benefits are covered, and include services not usually covered by Medicare plans.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. Some services, like In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, and others, are not covered.
Hearing Services See details
The SCAN Embrace (HMO I-SNP) plan covers hearing exams and fitting/evaluation for hearing aids with no deductible. Routine hearing exams are covered once per year. Prescription hearing aids are covered with a copay between $450 and $750, twice per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The SCAN Embrace (HMO I-SNP) plan covers vision services, including eye exams and eyewear. The plan covers one routine eye exam per year, and offers a combined maximum of $375 per year for eyewear. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each covered once per year. Upgrades are not covered.
Dental Services See details
The SCAN Embrace (HMO I-SNP) plan covers a variety of dental services. Other Diagnostic Dental Services have a copay of $0-$5, Other Preventive Dental Services have a copay of $0-$80, 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the SCAN Embrace (HMO I-SNP) plan. There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by SCAN Embrace (HMO I-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Prosthetic Devices have a coinsurance between 0% and 20% and Medical Supplies have a coinsurance between 0% and 20%; there is no copay for any of these services. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Embrace (HMO I-SNP), with Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services not covered. Diagnostic Radiological Services have a copay of up to $75, while Therapeutic Radiological Services have a copay of up to $60.
Home Health Services See details
Home Health Services are covered by the SCAN Embrace (HMO I-SNP) plan with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items with a maximum benefit of $200 every three months, including nicotine replacement therapy and Naloxone, but acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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