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SCAN Strive (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Strive (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Strive (HMO C-SNP) in 2025, please refer to our full plan details page.
SCAN Strive (HMO C-SNP) is a HMO C-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in Select Southern CA Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN Strive (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
SCAN Strive (HMO C-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 Strive (HMO C-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 Strive (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.70. 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 $590.00 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 $9350.00 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 Strive (HMO C-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you'll pay either a coinsurance or no copay depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay, while standard generic drugs have a 24% or 25% coinsurance depending on the pharmacy. After your total drug costs reach $2,000, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The SCAN Strive (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Many services, including preventive services, home health, and diagnostic and radiological services, have no copay. Outpatient, emergency, and primary care services often have a 20% coinsurance, along with services like vision, dental, and ambulance services. The plan also includes coverage for hearing and vision services, with limitations on hearing aid coverage and a $350 annual limit for vision eyewear. Other benefits include coverage for home infusion bundled services, medical equipment, and other services such as acupuncture and over-the-counter items. However, some services like cardiac rehabilitation and certain dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days, non-Medicare stays, and upgrades for acute and psychiatric care are not covered. The cost sharing for inpatient hospital services is the Medicare-defined cost share for tier 1, with more details available in the plan documents.
Outpatient Services See details
Outpatient Services are covered by the SCAN Strive (HMO C-SNP) plan, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, and outpatient blood services have a 20% coinsurance. Outpatient substance abuse services are partially covered, but individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Strive (HMO C-SNP) plan, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the SCAN Strive (HMO C-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to plan-approved health-related locations are covered, with 48 one-way trips per year using rideshare services, bus/subway, or medical transport, but 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 by the SCAN Strive (HMO C-SNP) plan. For Emergency Services and Urgently Needed Services, you will pay 20% coinsurance, while Worldwide Emergency Services has 20% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician, Chiropractic, Occupational Therapy, Physician Specialist, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology, Additional Telehealth, and Opioid Treatment Program Services are covered. Chiropractic services have a 20% coinsurance, and routine chiropractic care is limited to 30 visits per year. Occupational Therapy, Physical Therapy, Speech-Language Pathology services, have a 20% coinsurance, while Additional Telehealth benefits have a coinsurance between 0% and 20%. Individual and group sessions for Mental Health and Psychiatric Specialty Services, and Podiatry Services are not covered.
Preventive Services See details
The SCAN Strive (HMO C-SNP) plan covers preventive services including annual physical exams, health education, in-home safety assessments, personal emergency response systems, fitness benefits, remote access technologies, in-home support services, and support for caregivers with no copay. Kidney disease education services have a 20% coinsurance, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered. However, services such as medical nutrition therapy, post-discharge in-home medication reconciliation, and more are not covered.
Hearing Services See details
Hearing services are partially covered by SCAN Strive (HMO C-SNP), with a coinsurance of at most 20% for routine hearing exams. Fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with a 20% coinsurance for eye exams and eyewear. Eyewear has a combined maximum plan benefit coverage of $350 every year, and the plan covers one pair of contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames every year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services include oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, and prophylaxis (cleaning) (2 visits per year). Fluoride treatment, prosthodontics, and implant services are not covered. Orthodontic services are covered with a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the SCAN Strive (HMO C-SNP) plan. This plan requires prior authorization and a doctor referral, and has a 20% coinsurance.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance; Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all diagnostic and radiological services. Diagnostic Procedures/Tests and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services, Diagnostic Radiological Services, and Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by SCAN Strive (HMO C-SNP) with no copay and no coinsurance, but require both authorization and a referral. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the SCAN Strive (HMO C-SNP) plan. Prior authorization and a doctor's referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. The plan charges the Medicare-defined cost share for tier 1, but does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays.
Other Services See details
Under Other Services, acupuncture is covered with prior authorization, up to 24 treatments per year. Over-the-counter items are covered with a maximum benefit of $70.00 per month, including nicotine replacement therapy and naloxone. Meal benefits are covered with prior authorization. Some services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others.
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