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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 2025, 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 4.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For instance, preferred generic drugs have no copay at preferred pharmacies and preferred mail, while standard generic drugs have a $42 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. The plan is an enhanced alternative.
Additional Benefits
The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find coverage for primary care, preventive services with no copay, and specialized services like hearing, vision, and dental. This plan also includes ambulance and transportation services, emergency services, and home health services with no copay. Additionally, the plan provides benefits for home infusion, dialysis, medical equipment, and diagnostic services, with some services requiring coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is no copay for days 1-3 and days 8-90, and a $50 copay for days 4-7; Additional Days are covered, but Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, there is a $120 copay for days 1-5, and no copay for days 6-90; Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services are covered by the SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan, with copays ranging from $0 to $50 for Outpatient Hospital Services. Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services are also covered, while Outpatient Substance Abuse Services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan, requiring prior authorization and a doctor's referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services each have a $75 copay, and transportation services to a plan-approved health-related location are covered for 20 one-way trips per year, utilizing rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Worldwide Emergency Coverage, there is a $90 copay and no coinsurance. Worldwide Emergency Transportation has a $75 copay and no coinsurance. Urgently Needed Services has no copay and no coinsurance.
Primary Care See details
The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan covers primary care physician services, chiropractic services (with a $5 copay for routine care), occupational therapy, physician specialist services, psychiatric services (with a $20 copay for individual and group sessions), physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services (with a $20 copay). Mental health specialty services and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for services like health education and fitness benefits, with no copay or coinsurance, and additional preventive services including glaucoma screening and diabetes self-management training. The plan does not cover 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited; prescription hearing aids (all types) are covered for up to 2 visits per year with a copay between $550 and $850. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are over-the-counter (OTC) hearing aids.
Vision Services See details
The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan covers vision services including eye exams, eyewear, and contact lenses. Routine eye exams are covered once per year, and you can receive one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames each year; eyewear has a combined maximum benefit of $175 per year.
Dental Services See details
The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan covers various dental services, including oral exams and dental X-rays, limited to two visits per year, and other diagnostic dental services with a copay between $0 and $5. Other covered services include prophylaxis (cleaning) limited to two visits per year, other preventative dental services with a copay between $0 and $80, restorative services with a copay between $8 and $395, and oral and maxillofacial surgery with a copay between $0 and $140; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. You may have a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, and you will pay a $35 copay for Medicare Part B Insulin Drugs.
Dialysis Services See details
Dialysis Services are covered by SCAN Affirm partnered with Included LGBTQ+ Health (HMO), and require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan covers Durable Medical Equipment (DME) with 0% to 20% coinsurance, as well as Prosthetic Devices with 0% to 20% coinsurance. Medical Supplies are covered with 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a coinsurance of at most 20%, and there is no copay for any of these services.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but require authorization and a referral; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN Affirm partnered with Included LGBTQ+ Health (HMO). There is no copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $5 copay, over-the-counter (OTC) items with a $125 maximum benefit every three months, and a meal benefit; however, 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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