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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 Orange 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 $61.50. 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 with no deductible. In the initial coverage phase, you will pay no copay for preferred generic drugs. For standard generic drugs, you'll pay a copay of $42.00-$43.00 depending on the 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 $2,000.00, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The SCAN Embrace (HMO I-SNP) plan offers a range of benefits with varying costs. Many services, including primary care, preventive services, home health, and dialysis, come with no copay. Emergency Services have a $90 copay, while ambulance services have a $95 copay. The plan also includes coverage for hearing, vision, and dental services, each with specific limits and cost-sharing. Hearing exams are covered with no copay, and hearing aids are covered with copays between $450 and $750. Vision services cover routine eye exams and eyewear with a $375 annual limit. Dental services have varying copays depending on the procedure.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute is covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Embrace (HMO I-SNP) plan. There is no cost for this benefit.
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 $95 copay, while transportation services to plan-approved health-related locations are covered for up to 28 one-way trips per year with various modes of transportation.
Emergency Services See details
Emergency Services are covered under the SCAN Embrace (HMO I-SNP) plan, with a $90 copay and no coinsurance. Worldwide Emergency Coverage has a $90 copay, Worldwide Urgent Coverage has no copay, and Worldwide Emergency Transportation has a $95 copay, with no coinsurance for all of these services.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered with no copay and no coinsurance, but authorization and referrals may be required. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services are partially covered, with Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services not covered. Podiatry Services and Opioid Treatment Program Services are covered, but require authorization and a referral.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Additional covered services include health education, in-home support services, remote access technologies, fitness benefits, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, support for caregivers of enrollees, 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
The SCAN Embrace (HMO I-SNP) plan covers hearing exams with no deductible, and covers routine hearing exams once per year. Fitting/evaluation for hearing aids is covered with no limit. Prescription hearing aids are covered with a copay between $450 and $750 for 2 visits every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The SCAN Embrace (HMO I-SNP) plan covers vision services, including routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $375 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each limited to one per year. Upgrades are not covered.
Dental Services See details
The SCAN Embrace (HMO I-SNP) plan's dental services cover oral exams and dental x-rays, with a limit of 2 visits per year, and other diagnostic dental services with a copay of $0-$5. Additionally, the plan covers prophylaxis (cleaning) with a limit of 2 visits per year, restorative services with a copay of $8-$395, adjunctive general services with a copay of $0-$125, endodontics with a copay of $5-$395, periodontics with a copay of $0-$380, prosthodontics (removable) with a copay of $13-$395, prosthodontics (fixed) with a copay of $25-$395, and oral and maxillofacial surgery with 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, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0-20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0-20% coinsurance.
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 benefits are covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, and Prosthetics/Medical Supplies with 0% to 20% coinsurance and no copay. However, 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 no copay for all diagnostic services, and a copay of up to $75 for diagnostic radiological services and up to $60 for therapeutic radiological services; outpatient X-Ray Services, diagnostic procedures/tests and lab services are not covered. Prior authorization and a doctor referral are required for all diagnostic and radiological services.
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 additional hours of care and personal care services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. This plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C.
Other Services See details
The SCAN Embrace (HMO I-SNP) plan covers Over-the-Counter (OTC) items, with a maximum benefit of $200 every three months, including nicotine replacement therapy and naloxone coverage. 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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