SCAN Affirm partnered with Included LGBTQ+ Health (HMO)

SCAN Affirm partnered with Included LGBTQ+ Health (HMO) is a HMO 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 Affirm partnered with Included LGBTQ+ Health (HMO) 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 Affirm partnered with Included LGBTQ+ Health (HMO).

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 Affirm partnered with Included LGBTQ+ Health (HMO) plan features an Enhanced Alternative drug benefit with a $250 annual prescription drug deductible. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generic drugs have no copay at preferred pharmacies and preferred mail-order services. Standard generics in Tier 2 carry a $42 copay at preferred locations and a $47 copay at standard locations, while Tier 3 and Tier 4 drugs require 35% and 25% coinsurance, respectively. This initial coverage phase lasts until your total drug costs reach $2,100, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, members who qualify for the low-income subsidy can receive a premium reduction, lowering their Part D cost to nothing. To ensure your specific medications are covered, we recommend checking the plan's formulary.

Additional Benefits

The SCAN Affirm partnered with Included LGBTQ+ Health (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copays for Medicare-covered preventive services, urgent care, and inpatient hospital stays from days six to 90. For shorter inpatient stays, members pay a $150 daily copay for days one through five, while emergency room visits carry a $90 copay and outpatient hospital services require a $125 copay. Most primary care, therapy, and chiropractic services are highly affordable, featuring no coinsurance and copays ranging from no copay to $15. This plan also includes valuable everyday wellness benefits such as preventive dental care, an annual routine vision exam with a $250 eyewear allowance, and routine hearing exams with prescription hearing aid coverage. Additionally, members can take advantage of up to 32 one-way trips to plan-approved health locations, a $60 quarterly over-the-counter allowance, and acupuncture sessions with no coinsurance and a $10 copay. Most covered medical equipment and Part B drugs feature no copay and coinsurance ranging up to 20 percent.