SCAN Affirm partnered with Included LGBTQ+ Health (HMO)

SCAN Affirm partnered with Included LGBTQ+ Health (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Select Southern California Counties. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that SCAN Affirm partnered with Included LGBTQ+ Health (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 Affirm partnered with Included LGBTQ+ Health (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.

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:

Drug Coverage

The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan features an Enhanced Alternative drug benefit with a $250 prescription drug deductible. During the initial coverage phase, you will enjoy no copay on Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail service. Standard generic drugs in Tier 2 require a $42 copay at preferred locations, while standard pharmacies and mail orders charge a $47 copay. For brand-name and non-preferred medications, the plan requires coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 35% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs.

Additional Benefits

The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan offers comprehensive medical coverage with low out-of-pocket costs, featuring no copay for urgent care and routine preventive services. Emergency room visits carry a $90 copay, which is waived upon hospital admission, while ground and air ambulance services require a $200 copay with no coinsurance. Most standard medical services, including inpatient stays and outpatient care, are covered but require prior authorization and doctor referrals. Members also receive valuable supplemental benefits, such as routine dental care with no coinsurance and a $300 annual allowance for glasses and contacts. Routine hearing exams are covered with no copay, and prescription hearing aids are available with copays between $550 and $850. Additional perks include a $150 quarterly over-the-counter allowance, up to 20 one-way transportation trips, and post-hospitalization meals to support your recovery.