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SCAN Affirm partnered with Included LGBTQ+ Health (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Affirm partnered with Included LGBTQ+ Health (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Affirm partnered with Included LGBTQ+ Health (HMO) in 2026, please refer to our full plan details page.
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 San Diego County. 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.
For SCAN Affirm partnered with Included LGBTQ+ Health (HMO), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 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:
Sign up for SCAN Affirm partnered with Included LGBTQ+ Health (HMO)
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Drug Coverage
The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) prescription drug plan features a $250.00 annual deductible and offers Enhanced Alternative coverage. During the initial coverage phase, Tier 1 preferred generic drugs have no copay at preferred pharmacies or through preferred mail, but cost $15.00 at standard locations. Tier 2 standard generics require a $42.00 copay at preferred locations and $47.00 at standard locations, while Tier 3 preferred brands require 35% coinsurance and Tier 4 non-preferred drugs require 25% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy will pay $0.00 for their Part D costs.
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 preventive services and urgent care. Inpatient hospital stays require no copay for days 1 through 3 and 8 through 90, while emergency room visits carry a $90 copay that is waived if you are admitted. Outpatient hospital services are also highly affordable, with copays ranging from no copay up to $50 and no coinsurance. This plan also includes key supplemental benefits, such as routine dental care with copays ranging from no copay up to $395, and a $250 annual allowance for eyewear. Members can access routine hearing exams with no deductible, prescription hearing aids for a $550 to $850 copay, and a generous $175 quarterly over-the-counter allowance. Additionally, the plan covers up to 40 one-way transportation trips to approved locations and up to 30 acupuncture treatments per year.
Inpatient Hospital See details
Inpatient hospital benefits are covered by SCAN Affirm partnered with Included LGBTQ+ Health (HMO) with no coinsurance, though prior authorization and doctor referrals are required. For acute care, there is no copay for days 1-3 and 8-90, and a $50 daily copay for days 4-7, while psychiatric stays require a $120 daily copay for days 1-5 and no copay for days 6-90. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN Affirm partnered with Included LGBTQ+ Health (HMO) with copays ranging from no copay to $50 and no coinsurance for outpatient hospital services. However, outpatient substance abuse services are only partially covered, as both individual and group sessions are not covered.
Partial Hospitalization See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) covers ground and air ambulance services with a $75 copay and no coinsurance. Transportation services are partially covered, providing up to 40 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services are available with no copay and no coinsurance, while worldwide emergency coverage and transportation are covered with copays of $90 and $75, respectively, and no coinsurance.
Primary Care See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) partially covers Primary Care benefits, as podiatry and mental health specialty services are not covered. Covered psychiatric and opioid treatment services require a $20 copay and no coinsurance, while other services like chiropractic, telehealth, and physical therapy are covered but require prior authorization and referrals.
Preventive Services See details
Preventive Services are covered with no copay and no coinsurance under the SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan, including annual physical exams and kidney disease education. Additional preventive services are only partially covered, as medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management programs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, enhanced disease management, telemonitoring, home and bathroom safety devices, counseling, and additional smoking cessation counseling are not covered.
Hearing Services See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) partially covers hearing services, including routine hearing exams and fitting evaluations with no deductible. Covered prescription hearing aids require a $550 to $850 copay and no coinsurance, while OTC hearing aids along with 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 Affirm partnered with Included LGBTQ+ Health (HMO), which offers no deductible for one annual routine eye exam and a $250 yearly eyewear allowance, though upgrades are not covered. Copay and coinsurance information for these benefits is not specified.
Dental Services See details
Dental services are partially covered by SCAN Affirm partnered with Included LGBTQ+ Health (HMO), with copays ranging from no copay up to $395 and no coinsurance. While exams, cleanings, and various restorative procedures are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) covers home infusion bundled services, requiring prior authorization. Medicare Part B insulin drugs are covered for a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and carry no coinsurance to 20% coinsurance.
Dialysis Services See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) covers durable medical equipment and prosthetics with no copays and coinsurance ranging from no coinsurance to 20%, requiring prior authorization. Diabetic equipment is partially covered, as diabetic supplies are not covered, while diabetic therapeutic shoes and inserts are covered with no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) partially covers diagnostic and radiological services, offering therapeutic radiological services with a 20% coinsurance and no copay. Some diagnostic services are covered, but diagnostic procedures, tests, lab services, diagnostic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan, requiring prior authorization and a doctor referral. Specific copay and coinsurance details are not specified for this covered benefit.
Cardiac Rehabilitation Services See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) does not provide coverage for cardiac rehabilitation services. No coverage is available for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation sub-services.
Skilled Nursing Facility (SNF) See details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond Medicare-covered stays are not covered. Covered stays require prior authorization and a doctor referral, with no coinsurance, no copay for days 1 to 20, and a $50 daily copay for days 21 to 100.
Other Services See details
Other Services are partially covered by SCAN Affirm partnered with Included LGBTQ+ Health (HMO), featuring up to 30 acupuncture treatments per year, a recovery meal benefit, and a $175 quarterly over-the-counter allowance. Highly integrated dual-eligible SNP services are not covered, and specific copay or coinsurance costs are not detailed for the covered services.
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