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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 Northern 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 $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 $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 $250 prescription drug deductible. During the initial coverage phase, there is no copay for Tier 1 preferred generic drugs at any standard or preferred retail pharmacy or mail-order service. Other tiers require coinsurance, including 24% to 25% for Tier 2 standard generics, 30% for Tier 3 preferred brands, and 25% for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, those who qualify for the low-income subsidy, or Extra Help, can receive a reduced Part D premium of $0.
Additional Benefits
The SCAN Strive (HMO C-SNP) plan offers robust medical coverage with no copay and no coinsurance for primary care, specialist visits, and standard preventive services. Many outpatient, emergency, and diagnostic services, along with Medicare-covered dental and vision care, feature no copay and a 20% coinsurance. Inpatient hospital stays and skilled nursing facility care are also covered using Medicare-defined copays and coinsurance. This plan also includes extra benefits such as a $110 monthly over-the-counter allowance, up to 48 one-way transportation trips, and up to 24 acupuncture visits per year. However, beneficiaries should note that hearing services, cardiac rehabilitation, and diabetic supplies are not covered under this plan.
Inpatient Hospital See details
SCAN Strive (HMO C-SNP) partially covers inpatient acute and psychiatric hospital services, with cost-sharing based on Original Medicare-defined copays and coinsurance. Prior authorization and doctor referrals are required, and the plan does not cover additional days, non-Medicare-covered stays, or upgrades for acute care.
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. For outpatient substance abuse, some services are covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under the SCAN Strive (HMO C-SNP) plan, with prior authorization and a doctor referral required for services. Specific copay and coinsurance cost-sharing details are not specified for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by SCAN Strive (HMO C-SNP), requiring a 20% coinsurance and no copay for both ground and air ambulance services. Transportation benefits are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Strive (HMO C-SNP) covers Emergency Services, Urgently Needed Services, and Worldwide Emergency Services with a 20% coinsurance and no copay. These costs count toward the plan-level deductible, with maximum per-visit amounts capped at $115 for emergency services and $40 for urgent care.
Primary Care See details
SCAN Strive (HMO C-SNP) covers primary care, specialist, other health professional, and opioid treatment services with no copay and no coinsurance, while occupational, physical, speech, and routine chiropractic therapies require no copay and 20% coinsurance. Telehealth benefits are offered with no copay and no coinsurance to 20% coinsurance, but podiatry is not covered, and for mental health and psychiatric services, some services are covered but individual and group sessions are not.
Preventive Services See details
Preventive services are covered by SCAN Strive (HMO C-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar preventive services, though kidney disease education requires a 20% coinsurance. Additional preventive benefits are partially covered, including health education, fitness, and caregiver support, while services like medical nutrition therapy, weight management, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are not covered under the SCAN Strive (HMO C-SNP) plan, as routine hearing exams, fitting and evaluation, prescription hearing aids, and over-the-counter hearing aids are all excluded from coverage.
Vision Services See details
SCAN Strive (HMO C-SNP) partially covers vision services, offering one routine eye exam per year and eyewear up to a $325 annual limit with no copay and a 20% coinsurance. Prior authorization and doctor referrals are required for these benefits, and eyewear upgrades are not covered.
Dental Services See details
Dental services are covered by SCAN Strive (HMO C-SNP), including Medicare-covered dental services which require no copay and a 20% coinsurance. Other preventive and comprehensive services are also covered, though orthodontic services are only partially covered up to a $4,000 annual limit because orthodontics itself is not covered.
Home Infusion bundled Services See details
SCAN Strive (HMO C-SNP) covers Home Infusion bundled Services with prior authorization, featuring coinsurance ranging from no coinsurance to 20% for Part B drugs. Under this benefit, Medicare Part B insulin drugs require a $35 copay, while chemotherapy, radiation, and other Part B drugs have no copay.
Dialysis Services See details
Dialysis Services are covered by SCAN Strive (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
SCAN Strive (HMO C-SNP) covers durable medical equipment with no copay and no coinsurance to 20% coinsurance, and prosthetic devices and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered under this plan, offering therapeutic shoes and inserts with no copay and 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
SCAN Strive (HMO C-SNP) partially covers diagnostic and radiological services, offering a 20% coinsurance and no copay for diagnostic procedures, therapeutic radiological services, and outpatient X-rays. Lab services and diagnostic radiological services are not covered, and covered services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered under the SCAN Strive (HMO C-SNP) plan, requiring prior authorization and a doctor referral, though specific copay and coinsurance costs are not specified.
Cardiac Rehabilitation Services See details
SCAN Strive (HMO C-SNP) does not cover Cardiac Rehabilitation Services. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Strive (HMO C-SNP), with copays and coinsurance based on Medicare-defined cost-sharing rates. Prior authorization and a doctor referral are required, though a prior three-day hospital stay is not, and additional days beyond Medicare-covered care are not covered.
Other Services See details
SCAN Strive (HMO C-SNP) provides partially covered Other Services, which include a $110 monthly over-the-counter allowance, up to 24 acupuncture visits per year, and meal benefits, while Dual Eligible SNPs with Highly Integrated Services are not covered. Copay and coinsurance cost-sharing details for these covered services are not specified in the plan information.
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