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SCAN Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Classic (HMO) in 2025, please refer to our full plan details page.
SCAN Classic (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Fresno and Madera Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN Classic (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 Classic (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 Classic (HMO), 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 no drug deductible. Your prescription medication coverage will start immediately.
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:
Sign up for SCAN Classic (HMO)
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Drug Coverage
The SCAN Classic (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a $42 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The SCAN Classic (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $0-$120 copay depending on the type of care and the length of stay. Outpatient services have copays that range from $0 to $85, and emergency services cost a $90 copay. This plan also includes coverage for primary care, preventive services, hearing, vision, and dental. Hearing exams and hearing aid fitting/evaluation have no copay, while prescription hearing aids have copays between $450 and $750. Vision services include eye exams and eyewear, with a combined maximum benefit of $200. Additionally, the plan covers dental services, home infusion, dialysis, medical equipment, and more, with costs varying based on the specific service.
Inpatient Hospital See details
Inpatient hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization and a doctor referral required. For Inpatient Hospital-Acute, you will pay no copay for days 1-3 and days 8-90, and a $50 copay for days 4-7. For Inpatient Hospital Psychiatric, you will pay a $120 copay for days 1-10, and no copay for days 11-90.
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. Outpatient hospital services have a copay between $0 and $85, while individual and group sessions for outpatient substance abuse have a $20 copay.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $55 copay. Prior authorization and a doctor's referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Classic (HMO) plan. Ground and air ambulance services have a $75 copay, and transportation services to a plan-approved health-related location are covered for up to 32 one-way trips per year.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered by the SCAN Classic (HMO) plan. Emergency Services have a $90 copay, while Worldwide Emergency Transportation has a $75 copay. Worldwide Emergency Coverage also has a $90 copay. Urgently Needed Services have no copay.
Primary Care See details
The SCAN Classic (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, while individual and group sessions for mental health and psychiatric services, and podiatry services are not covered. Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, health education, personal emergency response systems, In-Home Support Services, support for caregivers, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan does not cover in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services with SCAN Classic (HMO) include hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids with no copay or coinsurance. Prescription hearing aids (all types) are covered with a copay between $450 and $750, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The SCAN Classic (HMO) plan covers vision services, including eye exams and eyewear, with prior authorization and a doctor referral required. Routine eye exams are covered once per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered once per year. Eyewear has a combined maximum plan benefit coverage of $200. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan offers other dental services as an optional supplemental benefit, and orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the SCAN Classic (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the SCAN Classic (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment. Diabetic Supplies are not covered, but Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for any of the covered services. Therapeutic Radiological Services have a coinsurance of at most 20%, and Medicare-covered X-Ray Services have a coinsurance, but the exact amount is not specified.
Home Health Services See details
Home Health Services are covered by the SCAN Classic (HMO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $50.
Other Services See details
Other Services include acupuncture with a $5 copay and over-the-counter items with a $90 maximum benefit every three months, and a meal benefit. However, 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, and Self-Directed Personal Assistance Services are not covered.
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