SCAN Balance (HMO C-SNP)

SCAN Balance (HMO C-SNP) is a HMO C-SNP plan offered by Scan Health Plan available for the 2026 plan year to people living in Fresno, Madera, Kings and Tulare Counties. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that SCAN Balance (HMO C-SNP) 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 Balance (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.

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:

Drug Coverage

The SCAN Balance (HMO C-SNP) Medicare plan offers Enhanced Alternative prescription drug coverage with a $250 annual drug deductible. After meeting this deductible, members enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail delivery. Standard generic drugs require a $42 copay at preferred locations, while preferred brand and non-preferred drugs are subject to 35% and 30% coinsurance, respectively. For individuals qualifying for the low-income subsidy, the Part D premium is reduced to $0. Standard pharmacies and standard mail orders have slightly higher costs, such as a $15 copay for Tier 1 generics and a $47 copay for Tier 2 generics. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.

Additional Benefits

The SCAN Balance (HMO C-SNP) plan offers robust medical coverage with no copay for preventive services, urgent care, and the first 20 days of a skilled nursing facility stay. Outpatient services feature affordable options with no coinsurance and copays ranging from no copay up to $85, while emergency care carries a $90 copay that is waived if you are admitted to the hospital. For specialized treatments, members pay a 20% coinsurance with no copay for dialysis and therapeutic radiology, and a $5 copay for acupuncture and routine chiropractic care. This plan also provides valuable everyday benefits, including covered dental services, a $300 annual eyewear allowance, and up to two prescription hearing aids per year for a copay of $550 to $850. Additionally, members can access up to 34 one-way trips annually to approved health locations and a $35 monthly allowance for over-the-counter items with no copay. While home health and medical equipment are covered, cardiac rehabilitation and diabetic supplies are not covered under this plan.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.