SCAN Balance (HMO C-SNP)

SCAN Balance (HMO C-SNP) is a HMO C-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in San Francisco County. 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 features an annual prescription drug deductible of $250.00 under its Enhanced Alternative drug benefit. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $15.00 copay. For Tier 2 standard generics, the plan requires a $42.00 copay at preferred locations and a $47.00 copay at standard locations. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs require a 35% and 30% coinsurance, respectively, across all pharmacy options. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions.

Additional Benefits

The SCAN Balance (HMO C-SNP) plan offers robust coverage for essential medical services, featuring no copays for primary care, specialist, chiropractic, and urgent care visits. For hospital stays, members pay a $150 copay per day for the first five days of acute inpatient care and a $125 copay for outpatient hospital visits, both with no coinsurance. Emergency services are also covered with a $90 copay that is waived if admitted, and the plan includes up to 28 one-way trips to approved health locations. This plan also provides valuable supplemental benefits, including routine hearing and vision exams with no copays, a $300 eyewear allowance every two years, and partial coverage for preventive and comprehensive dental care. Additionally, members benefit from no copays for the first 20 days in a skilled nursing facility and a $30 monthly over-the-counter allowance. While some specialized services like dialysis and durable medical equipment require up to a 20% coinsurance, the plan features no deductibles for vision services.