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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 2026, 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 out of 5 stars in 2026.
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 $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 $615.00 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 $9250.00 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) Medicare plan features an Enhanced Alternative drug benefit with a $615 prescription drug deductible. After meeting your deductible, you will pay no copay for Tier 1 preferred generic drugs through any pharmacy or mail-order option. For other medication tiers during the initial coverage phase, you can expect a coinsurance of 24% to 25% for Tier 2 standard generics, 30% for Tier 3 preferred brands, and 25% for Tier 4 non-preferred drugs. These initial rates apply until your yearly out-of-pocket drug costs reach $2,100, at which point you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy, also known as Extra Help, will pay nothing for their Part D coverage.
Additional Benefits
The SCAN Strive (HMO C-SNP) plan offers comprehensive medical coverage featuring no copays for many outpatient, primary care, emergency, and preventive services, though a 20% coinsurance typically applies. Inpatient hospital and skilled nursing facility stays are covered using standard Medicare-defined cost-sharing. Members also benefit from covered ambulance services and up to 60 one-way non-emergency transportation trips per year with no copay or coinsurance. Specialized benefits include routine vision and dental care, featuring a $350 annual eyewear allowance and up to $4,000 yearly for restorative dental services with no copays. Durable medical equipment and diagnostic services are covered with no copays and coinsurance ranging up to 20%. Additionally, the plan provides valuable extras like a $105 monthly over-the-counter allowance and limited acupuncture visits, though some services like cardiac rehabilitation and routine hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered under the SCAN Strive (HMO C-SNP) plan, with copays and coinsurance following Original Medicare-defined cost-sharing. Prior authorization and referrals are required, and specific sub-services such as additional days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
SCAN Strive (HMO C-SNP) covers outpatient hospital, observation, ambulatory surgical center, and blood services with a 20% coinsurance and no copay, though prior authorization and referrals are required. Outpatient substance abuse services, including individual and group sessions, are not covered under this plan.
Partial Hospitalization See details
Partial Hospitalization benefits are covered by SCAN Strive (HMO C-SNP), though prior authorization and a doctor referral are required to receive these services. Specific copay and coinsurance cost-sharing details are not provided in the plan benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under SCAN Strive (HMO C-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Strive (HMO C-SNP) covers emergency, urgently needed, and worldwide emergency services with a 20% coinsurance and no copay. These cost-sharing expenses count toward the plan-level deductible, with maximum per-visit limits of $115 for emergency services and $40 for urgent care.
Primary Care See details
SCAN Strive (HMO C-SNP) offers partially covered Primary Care benefits with no copays and coinsurance ranging from no coinsurance up to 20%. Podiatry is not covered, and although some psychiatric and mental health specialty services are covered, their individual and group sessions are not.
Preventive Services See details
Preventive services are partially covered by SCAN Strive (HMO C-SNP), offering Medicare-covered zero-dollar preventive services and annual physical exams with no copay or coinsurance. Covered kidney disease education requires a 20% coinsurance and no copay, but several sub-services are not covered, including medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, chemotherapy-related hair loss wigs, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional smoking and tobacco cessation counseling, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling services.
Hearing Services See details
Hearing services are covered under SCAN Strive (HMO C-SNP), but only some services are covered in practice as routine hearing exams, fitting and evaluation for hearing aids, prescription hearing aids, and over-the-counter hearing aids are not covered. There is no deductible, and because these services are not covered, there are no copays or coinsurance costs.
Vision Services See details
Vision services are partially covered by SCAN Strive (HMO C-SNP), which offers routine eye exams and eyewear with no copay and a 20% coinsurance. Covered eyewear includes glasses and contacts up to a $350 annual limit, but eyewear upgrades are not covered.
Dental Services See details
SCAN Strive (HMO C-SNP) offers partially covered dental services, with orthodontics being the only sub-service not covered. Medicare-covered dental services require prior authorization and have a 20% coinsurance and no copay, while other preventive and comprehensive dental benefits are covered with no copays or coinsurance, including up to $4,000 annually for restorative and surgical services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN Strive (HMO C-SNP) and require prior authorization. Covered Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Strive (HMO C-SNP) plan with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
SCAN Strive (HMO C-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries 0% to 20% coinsurance, prosthetics and medical supplies carry 20% coinsurance, and diabetic equipment is partially covered since diabetic supplies are not covered while diabetic therapeutic shoes and inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
SCAN Strive (HMO C-SNP) partially covers diagnostic and radiological services, requiring prior authorization and doctor referrals for covered care. Outpatient X-ray services and diagnostic procedures are covered with no copay and 20% coinsurance, 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), requiring both prior authorization and a doctor referral for members to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Strive (HMO C-SNP) plan, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage. Since these services are not covered, there are no copayment or coinsurance costs for members.
Skilled Nursing Facility (SNF) See details
SCAN Strive (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with Medicare-defined copays and no coinsurance, requiring prior authorization and a doctor referral. Standard Medicare-covered SNF days are included, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN Strive (HMO C-SNP), with Dual Eligible SNPs with Highly Integrated Services excluded from coverage. Covered benefits include up to 24 annual acupuncture treatments, a limited-duration meal benefit, and a $105 monthly over-the-counter allowance, although specific copay and coinsurance costs are not specified.
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