A non-government entity
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 2026, 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 out of 5 stars in 2026.
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 $15.00. 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 $999.00 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) Medicare plan offers an Enhanced Alternative drug benefit with a yearly prescription deductible of $250. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs when using preferred pharmacies or preferred mail order, while standard options require a $12 copay. Tier 2 standard generic drugs cost a $42 copay at preferred locations and a $47 copay at standard locations. For higher-tier medications, Tier 3 preferred brand drugs require 35% coinsurance, and Tier 4 non-preferred drugs require 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The SCAN Inspired by women for women (HMO) plan offers affordable medical coverage, featuring a $75 daily copay for inpatient hospital stays on days one through five and no copay for days six through 90. Emergency services carry a $90 copay, which is waived if you are admitted, while urgently needed care requires no copay. Additionally, primary care services feature no coinsurance, and routine preventive care and annual physicals are available with no copay. For routine care, the plan includes dental coverage up to a $3,000 annual maximum and a $345 yearly allowance for eyewear with no deductible. Hearing benefits feature one annual routine exam with no deductible and prescription hearing aid coverage with copays ranging from $350 to $650. Members also receive extra perks like a $150 quarterly over-the-counter allowance with no copay and acupuncture sessions for a $5 copay.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by SCAN Inspired by women for women (HMO), offering acute care with a $75 copay per day for days 1 to 5, no copay for days 6 to 90, and no coinsurance. However, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN Inspired by women for women (HMO), including outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Outpatient substance abuse sessions require a $10 copay with no coinsurance, while outpatient blood services have no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the SCAN Inspired by women for women (HMO) plan with a $10.00 copay and no coinsurance. Prior authorization and a doctor referral are required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under SCAN Inspired by women for women (HMO), with ground and air ambulance services requiring a $200 copay and no coinsurance. While the plan covers up to 42 one-way trips per year to plan-approved health-related locations, transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by SCAN Inspired by women for women (HMO) with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services require no copay or coinsurance, while worldwide emergency coverage features a $90 copay and worldwide emergency transportation has a $200 copay, both with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by SCAN Inspired by women for women (HMO), featuring no coinsurance for covered services, a $5 copay for routine chiropractic care, and a $10 copay for opioid treatment program services. Podiatry services, as well as individual and group sessions for both mental health specialty and psychiatric services, are not covered.
Preventive Services See details
SCAN Inspired by women for women (HMO) partially covers preventive services, offering Medicare-covered preventive care and annual physical exams with no copay and no coinsurance. Additional covered benefits include therapeutic massage for a $5 copay and no coinsurance, while sub-services like in-home safety assessments, home-based palliative care, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by SCAN Inspired by women for women (HMO), which includes one routine hearing exam per year and fitting evaluations with no deductible. Prescription hearing aids (all types) are covered up to two per year with a copay of $350 to $650 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by SCAN Inspired by women for women (HMO), requiring prior authorization and a doctor referral for one routine eye exam and eyewear per year. The plan features no deductible and a $345 annual limit for eyewear, though eyewear upgrades are not covered.
Dental Services See details
Dental services are covered by SCAN Inspired by women for women (HMO), though the benefit is partially covered as orthodontics is not covered. Covered treatments include exams, cleanings, and comprehensive procedures up to a $3,000 annual maximum, with prior authorization required for some services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the SCAN Inspired by women for women (HMO) plan with prior authorization. Covered Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Inspired by women for women (HMO) with a $25 copay and no coinsurance. Prior authorization and a doctor referral are required for these services.
Medical Equipment See details
Medical Equipment is partially covered under the SCAN Inspired by women for women (HMO) plan, as diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Covered services, including durable medical equipment, prosthetic devices, and medical supplies, require prior authorization and feature no copay with coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
SCAN Inspired by women for women (HMO) partially covers Diagnostic and Radiological Services, offering Therapeutic Radiological Services with a $50 copay and no coinsurance. While some diagnostic services are covered, Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered in practice.
Home Health Services See details
Home Health Services are covered under the SCAN Inspired by women for women (HMO) plan, requiring prior authorization and a doctor referral, though specific copay and coinsurance costs are not listed.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Inspired by women for women (HMO) plan. This lack of coverage applies to all related sub-services, including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by SCAN Inspired by women for women (HMO), requiring prior authorization and a doctor referral but no prior three-day inpatient hospital stay. While standard Medicare-covered days are included, additional days beyond the Medicare-covered limit are not covered, and specific copay or coinsurance details are not specified.
Other Services See details
SCAN Inspired by women for women (HMO) covers acupuncture for a $5 copay and no coinsurance for up to 30 treatments yearly, as well as meal benefits and a $150 quarterly over-the-counter allowance with no copay or coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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