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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 2026, 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 Orange County. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $21.00. 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) Medicare plan offers an Enhanced Alternative drug benefit with no prescription drug deductible. For Tier 1 preferred generic drugs, members enjoy no copay across all preferred, standard, and mail-order pharmacies. Tier 2 standard generic drugs carry a $42 copay at preferred pharmacies and preferred mail-order services, or a $43 copay at standard pharmacies and standard mail-order options. Tier 3 preferred brand drugs require a 35% coinsurance, while Tier 4 non-preferred drugs have a 33% 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 prescription drugs. Additionally, individuals who qualify for the low-income subsidy can see their Part D premium reduced to $0.
Additional Benefits
The SCAN Embrace (HMO I-SNP) plan offers comprehensive healthcare coverage with no deductibles for outpatient and vision services, alongside no copays for urgent care and routine preventive services. Emergency room visits require a $90 copay, which is waived if you are admitted, while ambulance services carry a $95 copay. Additionally, the plan supports your mobility by covering up to 40 one-way trips per year to plan-approved health-related locations. For specialized care, members enjoy no copays on preventive dental services, a $350 annual allowance for contacts or eyeglasses, and prescription hearing aid coverage with copays between $450 and $750. You also receive a $200 quarterly allowance for over-the-counter health items with no copay. Essential medical equipment is covered with no copay and 0% to 20% coinsurance, while Medicare Part B insulin is capped at a $35 copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by SCAN Embrace (HMO I-SNP), offering acute care with unlimited additional days and psychiatric care, with no cost sharing on the day of discharge. However, upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
SCAN Embrace (HMO I-SNP) covers outpatient hospital, observation, ambulatory surgical center, and outpatient blood services with no deductible. Some services are covered for outpatient substance abuse, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by SCAN Embrace (HMO I-SNP), although specific copay and coinsurance details are not specified in the plan's summary. Please contact the plan provider to verify any potential out-of-pocket costs associated with these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by SCAN Embrace (HMO I-SNP), with ground and air ambulance services requiring a $95 copay and no coinsurance. The plan also covers up to 40 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Embrace (HMO I-SNP) 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 covered with no copay and no coinsurance, while worldwide emergency coverage and transportation are available with copays of $90 and $95 respectively, and no coinsurance.
Primary Care See details
Primary Care benefits are covered by SCAN Embrace (HMO I-SNP), including primary care, specialist, and physical therapy services, though specific copay and coinsurance details are not specified. Chiropractic services are partially covered as routine chiropractic care is excluded, and while some mental health and psychiatric services are covered, individual and group sessions for both are not covered.
Preventive Services See details
Preventive services are partially covered by SCAN Embrace (HMO I-SNP), featuring no copay or coinsurance for Medicare-covered zero-dollar preventive services. While annual physicals, health education, memory fitness, and kidney disease education are covered, other services like in-home safety assessments, personal emergency response systems, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by SCAN Embrace (HMO I-SNP), featuring routine hearing exams and fitting evaluations with no coinsurance, and prescription hearing aids (all types) for a $450 to $750 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by SCAN Embrace (HMO I-SNP) with no deductibles, including one annual routine eye exam and a $350 yearly allowance for contacts or eyeglasses. However, eyewear upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by SCAN Embrace (HMO I-SNP), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Covered preventive care such as cleanings and oral exams requires no copay or coinsurance, while other covered diagnostic and comprehensive services have copays ranging from $0 to $395 and no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN Embrace (HMO I-SNP) and require prior authorization. Medicare Part B Insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Embrace (HMO I-SNP) plan. Specific copay and coinsurance cost-sharing details for these covered dialysis services are not specified in the plan's benefit overview.
Medical Equipment See details
Medical equipment benefits are partially covered by SCAN Embrace (HMO I-SNP), featuring no copay and 0% to 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. However, diabetic supplies and diabetic therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
SCAN Embrace (HMO I-SNP) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization and referrals for covered benefits. Diagnostic radiological services have a copay ranging from no copay to $75 and therapeutic radiological services require a $60 copay, while diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the SCAN Embrace (HMO I-SNP) plan, requiring prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Embrace (HMO I-SNP) plan, as all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Embrace (HMO I-SNP), requiring prior authorization but allowing admission without a prior three-day hospital stay. While standard Medicare-covered SNF days are provided with no specific copay or coinsurance details listed, additional days beyond what Medicare covers are not covered.
Other Services See details
SCAN Embrace (HMO I-SNP) partially covers Other Services, offering a $200 quarterly allowance for over-the-counter items that carries forward with no copay or coinsurance specified. Acupuncture, meal benefits, and dual eligible SNP services are not covered under this plan.
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