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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 Riverside and San Bernardino 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 $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) prescription drug plan features an annual deductible of $250. Under this plan, you will have no copay for tier 1 preferred generic drugs filled at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $9 copay. Tier 2 standard generic drugs carry a $42 copay at preferred pharmacies and a $47 copay at standard pharmacies. Higher-tier prescriptions require coinsurance, including 35% coinsurance for tier 3 preferred brand drugs and 30% coinsurance for tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers comprehensive medical coverage with predictable, low out-of-pocket costs, featuring no coinsurance for most primary, outpatient, and emergency services. Outpatient hospital services range from no copay to $50, while emergency room visits require a $90 copay that is waived if you are admitted. Standard preventive care is fully covered with no copay or coinsurance, helping you manage your health affordably. In addition to medical care, this plan provides valuable everyday benefits like dental care with no copay for preventive services and comprehensive dental copays up to $395. You also receive a $300 annual eyewear allowance, a routine annual hearing exam, and up to 46 one-way transportation trips per year. A $65 monthly over-the-counter allowance is also included with no copay or coinsurance to help cover health-related items.
Inpatient Hospital See details
SCAN Balance (HMO C-SNP) partially covers inpatient hospital services, requiring a doctor referral and prior authorization for both acute and psychiatric stays. While unlimited additional acute hospital days are covered with no cost sharing on the day of discharge, upgrades, non-Medicare-covered stays, and additional psychiatric days 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 $50 for outpatient hospital services and a $10 copay for outpatient substance abuse sessions. Ambulatory surgical center and blood services are also covered, with most services requiring prior authorization and a doctor referral.
Partial Hospitalization See details
SCAN Balance (HMO C-SNP) covers partial hospitalization benefits with a $10.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by SCAN Balance (HMO C-SNP), with ground and air ambulance services requiring a $200 copay and no coinsurance. While the plan covers up to 46 one-way trips per year to plan-approved health-related locations, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by SCAN Balance (HMO C-SNP) with a $90 copay and no coinsurance, and this copay is waived if you are admitted to the hospital. Urgently needed services require no copay and no coinsurance, while worldwide emergency coverage and worldwide emergency transportation are covered with copays of $90 and $200, respectively.
Primary Care See details
Primary Care benefits are partially covered by SCAN Balance (HMO C-SNP), featuring no coinsurance and copays ranging from $5 for routine chiropractic care to $10 for mental health and opioid treatment sessions. While services like primary care visits, physical therapy, and telehealth are covered, podiatry and psychiatric services are not covered by this plan.
Preventive Services See details
Preventive services are partially covered by SCAN Balance (HMO C-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar services, though prior authorization or referrals are required for certain benefits. Sub-services that are not covered under this plan include medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional tobacco cessation sessions, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by SCAN Balance (HMO C-SNP), including one annual routine hearing exam and unlimited fittings with no deductible. Prescription hearing aids are partially covered for up to two devices per year with a copay of $550 to $850 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered under SCAN Balance (HMO C-SNP), offering one routine eye exam and eyewear per year with no deductible and a $300 annual limit, though eyewear upgrades are not covered. Prior authorization and doctor referrals are required for exams and eyewear.
Dental Services See details
Dental services are partially covered by SCAN Balance (HMO C-SNP), offering preventive care with no copay and comprehensive services with copays ranging from $0 to $395, both with no coinsurance. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the SCAN Balance (HMO C-SNP) plan, requiring prior authorization. Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
SCAN Balance (HMO C-SNP) covers dialysis services with a $30 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered by SCAN Balance (HMO C-SNP) for durable medical equipment (DME) requiring prior authorization, though specific copay and coinsurance details are not specified. While some prosthetic and diabetic equipment services are covered, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered in practice.
Diagnostic and Radiological Services See details
SCAN Balance (HMO C-SNP) partially covers diagnostic and radiological services, though diagnostic services, diagnostic radiological services, and outpatient X-ray services are not covered. Covered therapeutic radiological services require a $25 copay and no coinsurance, as well as prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered under the SCAN Balance (HMO C-SNP) plan, though a doctor referral and prior authorization are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Balance (HMO C-SNP) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by SCAN Balance (HMO C-SNP), featuring no copay for days 1 through 20 and a $30 daily copay for days 21 through 100, with no coinsurance required. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SCAN Balance (HMO C-SNP) covers acupuncture with a $5 copay and no coinsurance for up to 30 treatments per year, as well as home meal benefits and a monthly $65 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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