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SCAN Balance (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Balance (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 Balance (HMO C-SNP) in 2026, please refer to our full plan details page.
SCAN Balance (HMO C-SNP) is a HMO C-SNP plan offered by SCAN Group available for enrollment in 2025 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.
Important:
SCAN Balance (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 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.
For SCAN Balance (HMO C-SNP), 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 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 $699.00 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 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.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by SCAN Balance (HMO C-SNP), requiring prior authorization and a doctor referral for both acute and psychiatric stays. Psychiatric stays incur a $120 daily copay for days 1 through 10, no copay for days 11 through 90, and no coinsurance, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
SCAN Balance (HMO C-SNP) covers outpatient services with no coinsurance, featuring copays ranging from no copay to $85 for outpatient hospital services and a $20 copay for outpatient substance abuse sessions. There is no deductible for outpatient blood services, and most of these benefits require prior authorization and a doctor referral.
Partial Hospitalization See details
SCAN Balance (HMO C-SNP) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
SCAN Balance (HMO C-SNP) covers ground and air ambulance services with a $75 copay and no coinsurance. Transportation services are partially covered, offering up to 34 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by SCAN Balance (HMO C-SNP) with a $90 copay and no coinsurance, which is waived upon hospital admission. Urgently needed services are available with no copay or coinsurance, and worldwide emergency services are covered with a $90 copay for emergency care, a $75 copay for emergency transportation, and no coinsurance.
Primary Care See details
SCAN Balance (HMO C-SNP) provides partially covered Primary Care benefits, though podiatry is not covered, and for mental health and psychiatric specialty services, only some services are covered as individual and group sessions are excluded. Covered benefits include routine chiropractic care with a $5.00 copay and opioid treatment program services with a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by SCAN Balance (HMO C-SNP) with no copay and no coinsurance for covered care such as annual physical exams and kidney disease education. However, multiple sub-services are not covered, including medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
Hearing services are partially covered by SCAN Balance (HMO C-SNP), which offers covered exams with no deductible and up to two prescription hearing aids (all types) annually for a copay of $550 to $850 and no coinsurance. Over-the-counter (OTC) hearing aids, alongside 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 Balance (HMO C-SNP) with no deductibles, offering one routine eye exam yearly and a $300 annual limit for eyewear, though upgrades are not covered. Prior authorization and a doctor referral are required for exams and eyewear, which include covered options for contact lenses and eyeglasses.
Dental Services See details
Dental services are covered by SCAN Balance (HMO C-SNP), including preventive exams, cleanings, x-rays, and comprehensive procedures like periodontics and implants. Orthodontic services are partially covered up to a $3,000 annual limit, though specific orthodontics treatments are not covered, and copay or coinsurance details are not specified.
Home Infusion bundled Services See details
SCAN Balance (HMO C-SNP) covers home infusion bundled services, requiring prior authorization, with coinsurance ranging from no coinsurance to 20% and no copay for chemotherapy, radiation, and other Part B drugs. Covered Part B insulin drugs require a $35 copay alongside coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by SCAN Balance (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
SCAN Balance (HMO C-SNP) covers medical equipment with no copays and coinsurance ranging from no coinsurance up to 20% for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is partially covered, offering diabetic therapeutic shoes and inserts for no copay and 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
SCAN Balance (HMO C-SNP) partially covers diagnostic and radiological services. For diagnostic services, some services are covered with no copay and no coinsurance, but diagnostic procedures and lab services are not covered; therapeutic radiological services are covered with a 20% coinsurance and no copay, while diagnostic radiological and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the SCAN Balance (HMO C-SNP) plan, requiring prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Balance (HMO C-SNP) plan, as all associated sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Balance (HMO C-SNP), requiring a doctor referral and prior authorization. There is no copay or coinsurance for days 1 through 20, and a $50 daily copay with no coinsurance for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SCAN Balance (HMO C-SNP) provides coverage for several other services, including acupuncture with a $5 copay and no coinsurance, as well as meal benefits and over-the-counter items with no copay or coinsurance. Over-the-counter items are limited to a $35 monthly allowance, while Dual Eligible SNPs with Highly Integrated Services are not covered.
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