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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 2025, 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 Riverside and San Bernardino Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $53.00. You must continue to pay paying your reduced 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 $399.00 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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies and mail order, while standard generic drugs have a $42 copay at preferred pharmacies. For preferred brand drugs and non-preferred drugs, you will pay 50% and 33% coinsurance, respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers a variety of benefits with varying costs. The plan covers hospital stays, outpatient services, and partial hospitalization with copays ranging from $0 to $50. Emergency services, ambulance services, and transportation to health-related locations are also covered, with copays ranging from $90 to $200. This plan includes coverage for primary care, hearing, vision, and dental services. Primary care and vision services have no copay, while hearing aids have a copay between $550 and $850. Dental services have copays ranging from $0 to $395. The plan also covers home infusion, dialysis, medical equipment, and home health services, with some services requiring prior authorization or a doctor's referral.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute are covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the SCAN Balance (HMO C-SNP) plan. Outpatient Hospital Services have a copay between $0 and $50, while individual and group sessions for outpatient substance abuse have a $10 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the SCAN Balance (HMO C-SNP) plan, with a $10 copay. This benefit requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
The SCAN Balance (HMO C-SNP) plan covers ambulance services with a $200 copay for both ground and air ambulance services, with no coinsurance. Transportation services to plan-approved health-related locations are covered for up to 36 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Emergency Transportation are covered by the SCAN Balance (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, and Worldwide Emergency Transportation has a $200 copay, but there is no coinsurance for any of these services. Worldwide Urgent Coverage is covered.
Primary Care See details
Under the SCAN Balance (HMO C-SNP) plan, primary care services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Routine chiropractic care has a $5 copay, individual and group sessions for mental health specialty services, and opioid treatment program services have a $10 copay, while other services have no copay or coinsurance.
Preventive Services See details
The SCAN Balance (HMO C-SNP) plan covers preventive services, including annual physical exams, health education, in-home safety assessments, personal emergency response systems, fitness benefits, remote access technologies, support for caregivers, and in-home support services. This plan does not cover 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, or counseling services.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, with some services requiring a doctor referral and prior authorization. Routine hearing exams are covered once per year. Fitting/evaluation for hearing aids is covered with no copay. Prescription hearing aids (all types) are covered with a copay between $550 and $850, limited to two per year. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The SCAN Balance (HMO C-SNP) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum plan benefit of $350 every year. The plan covers one pair of contact lenses, one pair of eyeglasses (lenses and frames), one pair of eyeglass lenses, and one pair of eyeglass frames every year. Upgrades are not covered.
Dental Services See details
The SCAN Balance (HMO C-SNP) plan covers a range of dental services. Other Diagnostic Dental Services, Oral and Maxillofacial Surgery, and Adjunctive General Services have copays ranging from $0 to $125. Restorative Services, Endodontics, Prosthodontics, removable, and Prosthodontics, fixed have copays ranging from $5 to $395. Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) are limited to 2 visits per year. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Balance (HMO C-SNP) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%, while other Medicare Part B drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN Balance (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The copay for these services is between $30.00 and $30.00.
Medical Equipment See details
Medical Equipment benefits are covered, with no copay or coinsurance for Durable Medical Equipment (DME) and Prosthetics/Medical Supplies. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the SCAN Balance (HMO C-SNP) plan. The plan covers Therapeutic Radiological Services with a copay of at most $25.00, but does not cover Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, or Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the SCAN Balance (HMO C-SNP) plan, with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, 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 $30.
Other Services See details
The SCAN Balance (HMO C-SNP) plan covers acupuncture with a $5 copay, up to 30 treatments per year, and requires prior authorization. Over-the-counter (OTC) items are covered with a maximum benefit of $125 every three months, and the plan also offers a meal benefit. However, other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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