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SCAN Inspired by women for women (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Inspired by women for women (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Inspired by women for women (HMO) in 2025, please refer to our full plan details page.
SCAN Inspired by women for women (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Los Angeles and Orange Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN Inspired by women for women (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 Inspired by women for women (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 Inspired by women for women (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $299.00 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 Inspired by women for women (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and where you fill your prescription. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, while standard generic drugs have a $42 or $47 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. The plan offers an enhanced alternative drug benefit. If you qualify for the low-income subsidy, you may have your premium reduced.
Additional Benefits
The SCAN Inspired by women for women (HMO) plan offers a wide range of benefits. This plan includes coverage for inpatient and outpatient services, along with emergency, primary care, preventive, hearing, vision, and dental services. This plan has a $50 copay for inpatient hospital stays for days 1-5, a $90 copay for emergency services, and a $200 copay for ambulance services. The plan also provides additional benefits such as acupuncture, an over-the-counter allowance, and transportation services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor's referral. For Inpatient Hospital-Acute, there is a $50 copay for days 1-5, and no copay for days 6-90; additional days are unlimited with no copay. Inpatient Hospital Psychiatric does not have any additional cost information. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Individual and group sessions for outpatient substance abuse have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered, requiring prior authorization and a doctor referral. You will have a $10 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services, with a $200 copay for both ground and air ambulance services, and transportation services to a plan-approved health-related location, with 26 one-way trips covered every year. Transportation services to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered, with a $90 copay and no coinsurance; the copay is waived if admitted to the hospital. Urgently Needed Services are covered with no copay and no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage with a $90 copay, Worldwide Urgent Coverage (copay not specified), and Worldwide Emergency Transportation with a $200 copay.
Primary Care See details
The SCAN Inspired by women for women (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care has a $5 copay for up to 30 visits per year, and opioid treatment program services have a $10 copay. Mental health and psychiatric individual and group sessions, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, annual physical exams, additional preventive services, health education, personal emergency response systems, wigs for hair loss related to chemotherapy (with a $300 maximum), weight management programs (with a $100 maximum), therapeutic massage with a $5 copay, fitness benefits, remote access technologies, in-home support services, and support for caregivers of enrollees. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all of which require prior authorization.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids are covered with no deductible. Prescription hearing aids (all types) are covered, with a copay between $450 and $750, but prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $345 every year for eyewear. Upgrades are not covered.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Oral exams and dental x-rays are limited to two visits per year, and other diagnostic dental services have a copay of $0-$5. Other preventive services have a copay of $0-$80, restorative services have a copay of $8-$395, adjunctive services have a copay of $0-$125, endodontics have a copay of $5-$395, periodontics have a copay of $0-$380, removable prosthodontics have a copay of $13-$395, fixed prosthodontics have a copay of $25-$395, and oral and maxillofacial surgery has a copay of $0-$140. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. The copay for Dialysis Services is $25.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies - Non-Medicare benefit with a coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Inspired by women for women (HMO), with no copay for all diagnostic services, but Diagnostic Procedures/Tests, and Lab Services are not covered. Therapeutic Radiological Services have a copay of at most $50.00, while Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Inspired by women for women (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required for SNF services.
Other Services See details
The SCAN Inspired by women for women (HMO) plan covers acupuncture with a $5 copay, up to 30 treatments per year, and also offers over-the-counter (OTC) items with a maximum benefit coverage amount of $125 every three months. This plan also provides a meal benefit and other services, but certain services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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