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SCAN MyChoice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN MyChoice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN MyChoice (HMO) in 2025, please refer to our full plan details page.
SCAN MyChoice (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Select Southern CA Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN MyChoice (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 MyChoice (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.
For SCAN MyChoice (HMO), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $199.00 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:
Sign up for SCAN MyChoice (HMO)
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Drug Coverage
The SCAN MyChoice (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay, while standard generic drugs have a copay of $42.00 or $43.00 depending on the pharmacy. Preferred and standard brand drugs have a 50% coinsurance, and non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The SCAN MyChoice (HMO) plan offers a range of benefits with varying cost-sharing. Many services, like primary care, preventive services, and vision exams, have no copay, while others, such as outpatient substance abuse and opioid treatment, have a $10 copay. The plan also covers hearing exams and hearing aids with copays, along with dental services that have copays depending on the service. Additionally, this plan includes coverage for inpatient and outpatient services, ambulance, emergency services, and home health services. You can also expect coverage for home infusion, dialysis, and medical equipment with authorization. Other benefits include acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but Non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered. Prior authorization and a doctor referral are required for both acute and psychiatric care.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient substance abuse services have a copay of $10 for both individual and group sessions, and outpatient blood services have a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN MyChoice (HMO) with a $10 copay, and requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the SCAN MyChoice (HMO) plan. Ground and Air Ambulance Services have a $100 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $100 copay; all have no coinsurance.
Primary Care See details
The SCAN MyChoice (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, additional telehealth benefits, and opioid treatment program services require prior authorization and a doctor referral. Individual and group sessions for mental health and psychiatric services are not covered. Occupational therapy and physical therapy services have no copay or coinsurance. Opioid treatment program services have a copay of $10.00.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered with no copay. The plan also covers Health Education, In-Home Support Services, Support for Caregivers of Enrollees, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered by SCAN MyChoice (HMO), including hearing exams and fitting/evaluation for hearing aids. Routine hearing exams are covered once per year, and prescription hearing aids (all types) are covered with a copay between $550 and $850 for two visits per year. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
The SCAN MyChoice (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum plan benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, but upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers a range of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Other diagnostic dental services have a copay between $0 and $5, while other preventive dental services have a copay between $0 and $80. Restorative services have a copay between $8 and $395, adjunctive general services have a copay between $0 and $125, endodontics have a copay between $5 and $395, periodontics have a copay between $0 and $380, prosthodontics (removable) have a copay between $13 and $395, prosthodontics (fixed) have a copay between $25 and $395, and oral and maxillofacial surgery have a copay between $0 and $140. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN MyChoice (HMO) plan, and require prior authorization and a doctor's referral. The copay for Dialysis Services is $25.
Medical Equipment See details
Medical Equipment benefits are covered by SCAN MyChoice (HMO), including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit with no copay or coinsurance, but authorization is required. Diabetic Equipment is also covered, but 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 MyChoice (HMO) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a copay of at most $50.00.
Home Health Services See details
Home Health Services are covered by the SCAN MyChoice (HMO) plan with no copay or coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. 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 additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor's referral are required.
Other Services See details
Under Other Services, SCAN MyChoice (HMO) covers acupuncture with prior authorization for up to 30 treatments per year, and over-the-counter items up to $75 every three months, which can carry over if unused, as well as a meal benefit with prior authorization. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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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