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SCAN Embrace (HMO-POS I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Embrace (HMO-POS 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-POS I-SNP) in 2025, please refer to our full plan details page.
SCAN Embrace (HMO-POS I-SNP) is a HMO-POS I-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in San Bernardino 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-POS 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-POS 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-POS 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-POS 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 $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 combined Maximum Out-Of-Pocket cost of $799.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $799.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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-POS I-SNP) plan has a $0 deductible for prescription drugs. For those who qualify for the low-income subsidy, the plan has no copay. In the initial coverage phase, you will pay no copay for preferred generic drugs, and $42-$43 for standard generic drugs. You will pay 50% coinsurance for preferred brand drugs and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The SCAN Embrace (HMO-POS I-SNP) plan offers comprehensive coverage including inpatient and outpatient services, emergency and urgent care, and various therapies like physical and speech therapy. This plan also covers preventive services, hearing and vision care, and dental services, with specific copays varying by service. Additionally, the plan provides benefits for medical equipment, home health services, and other services like over-the-counter items, with some services requiring prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, nor are additional days or non-Medicare-covered stays for Inpatient Hospital Psychiatric.
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 partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Embrace (HMO-POS I-SNP) plan. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $95 copay. Transportation Services to a plan-approved health-related location are covered for up to 30 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the SCAN Embrace (HMO-POS I-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $95 copay; Urgently Needed Services and Worldwide Urgent Coverage have no copay.
Primary Care See details
The SCAN Embrace (HMO-POS I-SNP) plan covers primary care physician services, occupational therapy, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services, mental health specialty services (individual and group sessions), and individual psychiatric sessions are partially covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services, though some additional services like In-Home Safety Assessment, Personal Emergency Response System, and others are not covered. In-Home Support Services and Fitness Benefit are covered.
Hearing Services See details
Hearing services are covered, including hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $550 and $850, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The SCAN Embrace (HMO-POS I-SNP) plan covers vision services, including routine eye exams with one visit covered every year, and eyewear with a combined maximum benefit of $375.00 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, but upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with copays ranging from $0 to $395 depending on the service. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Embrace (HMO-POS I-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay, 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 with this plan.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, Prosthetic Devices with 0% to 20% coinsurance and no copay, and Medical Supplies with 0% to 20% coinsurance and no copay; however, DME 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 under the SCAN Embrace (HMO-POS I-SNP) plan. Diagnostic procedures, tests, and lab services are not covered, while diagnostic radiological services have a copay of at most $75 and therapeutic radiological services have a copay of at most $60. Outpatient X-Ray services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Embrace (HMO-POS I-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for this benefit.
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 over-the-counter (OTC) items, with a maximum benefit coverage amount of $200.00 every three months, and nicotine replacement therapy (NRT) and Naloxone coverage; however, 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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