A non-government entity
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 2026, 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 out of 5 stars in 2026.
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 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 $999.00 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 MyChoice (HMO) plan features an enhanced alternative drug benefit with an annual prescription drug deductible of $250. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs at any pharmacy or mail-order service. For Tier 2 standard generic drugs, you will pay a $42 copay at preferred pharmacies and mail-order, or a $43 copay at standard pharmacies and mail-order. Tier 3 preferred brand drugs require a 35% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. Additionally, those who qualify for the low-income subsidy can reduce their Part D cost to $0.
Additional Benefits
The SCAN MyChoice (HMO) plan offers affordable core medical coverage, featuring a $50 copay for the first three days of inpatient hospital stays and no copay for days four through ninety. Outpatient hospital services require a $50 copay, while primary care doctor visits, physical therapy, and telehealth are covered with no coinsurance. Emergency room visits carry a $90 copay, which is waived upon admission, and home health services are available with no copay or coinsurance. For supplemental care, the plan provides preventive services and annual physicals with no copay or coinsurance, alongside a $240 eyewear allowance every three months. Routine hearing exams require no coinsurance, and up to two prescription hearing aids are covered annually with a copay of $550 to $850. Members also receive partial dental coverage, acupuncture for a $10 copay, and over-the-counter items with no copay.
Inpatient Hospital See details
SCAN MyChoice (HMO) partially covers inpatient hospital acute and psychiatric services with a $50 copay for days 1-3, no copay for days 4-90, and no coinsurance. Prior authorization and referrals are required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN MyChoice (HMO) covers outpatient services with a $50 copay for outpatient hospital and ambulatory surgical center services, and a $10 copay for outpatient substance abuse sessions, with no coinsurance required. Prior authorization and doctor referrals are required for most of these services, which also include outpatient blood services with no copay and no deductible.
Partial Hospitalization See details
SCAN MyChoice (HMO) covers partial hospitalization services with a $10.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered benefits.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by SCAN MyChoice (HMO), with ground and air ambulance services requiring a $100 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
SCAN MyChoice (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency services require a $90 copay for emergency coverage and a $100 copay for emergency transportation.
Primary Care See details
Primary Care benefits are covered by SCAN MyChoice (HMO), which includes doctor visits, physical therapy, and telehealth with no coinsurance. Routine chiropractic care is available for a $5 copay and opioid treatment requires a $10 copay, both with no coinsurance, while podiatry, psychiatric, and mental health specialty services are not covered.
Preventive Services See details
SCAN MyChoice (HMO) provides partially covered preventive services with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physical exams, and health education. Prior authorization and doctor referrals are required for some benefits, but sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, tobacco cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
SCAN MyChoice (HMO) partially covers hearing services, which include routine hearing exams and fittings with no coinsurance, and up to two prescription hearing aids per year for a copay of $550 to $850 and no coinsurance. OTC hearing aids, as well as prescription hearing aids for the inner ear, outer ear, and over the ear, are not covered.
Vision Services See details
SCAN MyChoice (HMO) covers vision services with no deductible, offering one routine eye exam annually and a $240 eyewear allowance every three months for contacts or eyeglasses. Doctor referrals and prior authorizations are required for these benefits, and eyewear upgrades are not covered.
Dental Services See details
SCAN MyChoice (HMO) dental services are partially covered, including preventive care, Medicare-covered dental services, and restorative treatments, though orthodontics is not covered. Prior authorization is required for Medicare dental services, and orthodontic services have a maximum coverage limit of $240 every three months.
Home Infusion bundled Services See details
SCAN MyChoice (HMO) covers home infusion bundled services with prior authorization, requiring no copay and ranging from no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
SCAN MyChoice (HMO) covers Dialysis Services with a $25 copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered services.
Medical Equipment See details
Medical Equipment is partially covered by SCAN MyChoice (HMO), which covers Durable Medical Equipment (DME) with prior authorization, though specific copay and coinsurance costs are not specified. However, several sub-services are not covered, including prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN MyChoice (HMO), with covered therapeutic radiological services requiring a $50 copay and no coinsurance. Other sub-services, including diagnostic procedures and tests, lab services, diagnostic radiological services, and outpatient X-ray services, are not covered.
Home Health Services See details
Home Health Services are covered under the SCAN MyChoice (HMO) plan with no copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN MyChoice (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by SCAN MyChoice (HMO), requiring prior authorization and a doctor referral but no prior three-day inpatient hospital stay. While standard Medicare-covered SNF days are included, additional days beyond the Medicare-covered limit are not covered, and specific copay or coinsurance costs are not specified in the plan terms.
Other Services See details
SCAN MyChoice (HMO) partially covers other services, providing meal benefits and over-the-counter items with no copay or coinsurance, and acupuncture with a $10 copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered.
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