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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 Northern 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 $25.90. 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 will pay either a coinsurance or no copay for your prescriptions. For preferred generic drugs, there is no copay. For standard generic drugs, you will pay 24% or 25% coinsurance, depending on the pharmacy.
Additional Benefits
The SCAN Strive (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services with a 20% coinsurance. You'll also have access to emergency services, ambulance services, and transportation, all with a 20% coinsurance. Preventive services, vision, dental, and home health services are covered, with varying copays or coinsurance amounts for different services. This plan provides coverage for home infusion, dialysis, and medical equipment, with some services requiring prior authorization. There is also coverage for other services like acupuncture, OTC items, and a meal benefit. However, some services, such as cardiac rehabilitation, are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the SCAN Strive (HMO C-SNP) plan. Additional days, non-Medicare-covered stays, and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient blood services, are covered by SCAN Strive (HMO C-SNP) with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services are covered with a coinsurance between 20%. Outpatient Substance Abuse Services are partially covered, as individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. There is no information available regarding the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered under the SCAN Strive (HMO C-SNP) plan, with a 20% coinsurance for both. Transportation services to plan-approved health-related locations are covered for up to 48 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. Emergency and Urgently Needed Services have a 20% coinsurance, and Worldwide Emergency Services has a 20% coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The SCAN Strive (HMO C-SNP) plan covers Primary Care Physician Services, Chiropractic Services with 20% coinsurance, Occupational Therapy Services with 20% coinsurance, Physician Specialist Services, and Other Health Care Professional services. The plan does not cover Individual and Group Sessions for Mental Health and Psychiatric Services, and Podiatry Services. Physical Therapy and Speech-Language Pathology Services have 20% coinsurance. Additional Telehealth Benefits are covered with 0-20% coinsurance.
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, support for caregivers, and In-Home Support Services. Kidney Disease Education Services are covered with 20% coinsurance, and other preventive services, such as glaucoma screenings, and diabetes self-management training, are covered with prior authorization. However, some services, including medical nutrition therapy, are not covered.
Hearing Services See details
Hearing services are partially covered by SCAN Strive (HMO C-SNP), with some services requiring prior authorization and a doctor referral. Hearing exams have a coinsurance of at most 20%, and routine hearing exams are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, have a 20% coinsurance and a combined maximum benefit of $325 per year, with one pair of contact lenses, one pair of eyeglasses (lenses and frames), one pair of eyeglass lenses, and one eyeglass frame covered per year. Upgrades are not covered.
Dental Services See details
The SCAN Strive (HMO C-SNP) plan covers dental services with a 20% coinsurance for Medicare dental services, and has no maximum plan benefit coverage. The plan does not cover fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, orthodontics, and prosthodontics, fixed.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Strive (HMO C-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the SCAN Strive (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and Prosthetics/Medical Supplies with no copay and a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the SCAN Strive (HMO C-SNP) plan. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Strive (HMO C-SNP) plan 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 SCAN Strive (HMO C-SNP). Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The SCAN Strive (HMO C-SNP) plan covers acupuncture with prior authorization, up to 24 treatments per year, and over-the-counter (OTC) items with a $70 monthly maximum benefit; it also offers a meal benefit with prior authorization, but does not cover Dual Eligible SNPs with Highly Integrated Services. This plan does not cover 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, or Self-Directed Personal Assistance Services.
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