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 San Diego County. 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 $1000.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The SCAN MyChoice (HMO) prescription drug plan features an Enhanced Alternative drug benefit with a $250.00 annual drug deductible. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs at both standard and preferred pharmacies or mail-order services. For other tiers, you will pay a $42.00 or $43.00 copay for Tier 2 standard generics, a 35% coinsurance for Tier 3 preferred brands, and a 30% coinsurance for Tier 4 non-preferred drugs. These cost-sharing rates apply during the initial coverage phase until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy can reduce their Part D premium cost to zero dollars.
Additional Benefits
The SCAN MyChoice (HMO) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for most major services. Inpatient hospital stays require no copay for days 1 through 3 and 8 through 90, with a $100 daily copay for days 4 through 7. Additionally, members pay no copay for ambulatory surgical center services and urgently needed care, while emergency room visits carry a $90 copay that is waived upon hospital admission. For everyday wellness, the plan features no copay for preventive services, annual physicals, over-the-counter items, and meal benefits. Vision and dental benefits are partially covered, including a $245 eyewear allowance every three months alongside coverage for dental exams, cleanings, and restorative care. Hearing aids are also available with copays ranging from $550 to $850, and skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are partially covered by SCAN MyChoice (HMO) with no coinsurance, featuring no copay for acute days 1-3 and 8-90 ($100 daily copay for days 4-7) and a $120 daily copay for psychiatric days 1-5 (no copay for days 6-90). Non-Medicare-covered stays, upgrades for acute care, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN MyChoice (HMO) covers outpatient services with no coinsurance, featuring a $0 to $100 copay for outpatient hospital services and no copay for ambulatory surgical center services. Outpatient substance abuse services require a $20 copay per session, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
SCAN MyChoice (HMO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization and doctor referrals are required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by SCAN MyChoice (HMO), which covers ground and air ambulance services with a $75 copay and no coinsurance, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered under SCAN MyChoice (HMO) with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services are available with no copay and no coinsurance, while worldwide emergency coverage and transportation are covered with copays of $90 and $75 respectively and no coinsurance.
Primary Care See details
Primary care benefits are covered by SCAN MyChoice (HMO) with no coinsurance, featuring a $5 copay for routine chiropractic care and a $20 copay for opioid treatment. Podiatry is not covered, and while mental health and psychiatric services are technically covered, individual and group sessions for both services are not covered.
Preventive Services See details
SCAN MyChoice (HMO) provides partially covered preventive services, featuring no copay and no coinsurance for Medicare-covered zero-dollar services, annual physical exams, and kidney disease education. While health education, caregiver training, and memory fitness benefits are included, several sub-services are not covered, such as in-home safety assessments, personal emergency response systems, weight management programs, therapeutic massage, and adult day health services.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), which includes coverage for hearing exams and up to two prescription hearing aids per year with a copay of $550 to $850 and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
SCAN MyChoice (HMO) partially covers vision services with no deductibles, offering one routine eye exam per year and a $245 eyewear allowance every three months. Prior authorization and doctor referrals are required, and eyewear upgrades are not covered.
Dental Services See details
SCAN MyChoice (HMO) offers partially covered dental services with no copay or coinsurance specified, although orthodontics is not covered. Covered treatments include exams, cleanings, and restorative care, with orthodontic services limited to a maximum benefit of $245 every three months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SCAN MyChoice (HMO) with prior authorization, featuring a $35 copay and up to 20% coinsurance (with a minimum of no coinsurance) for Medicare Part B insulin. Chemotherapy and other covered Part B drugs have no copay and up to 20% coinsurance (with a minimum of no coinsurance).
Dialysis Services See details
Dialysis Services are covered by SCAN MyChoice (HMO) with a $30 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical Equipment is covered by SCAN MyChoice (HMO) with no copays and coinsurance ranging from no coinsurance to 20% for durable medical equipment and prosthetics. Diabetic equipment is partially covered, as diabetic supplies are not covered, though diabetic shoes and inserts are covered with no copay and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by SCAN MyChoice (HMO), with prior authorization and a doctor referral required for care. While diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-ray services are not covered, therapeutic radiological services are covered with a $50 copay and no coinsurance.
Home Health Services See details
Home health services are covered by the SCAN MyChoice (HMO) plan, though a doctor referral and prior authorization are required to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN MyChoice (HMO) plan, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $50 daily copay for days 21 through 100. Prior authorization and a doctor referral are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services covered by SCAN MyChoice (HMO) include acupuncture, over-the-counter items, and meal benefits, while Dual Eligible SNPs are not covered. Acupuncture requires a $5 copay and no coinsurance for up to 20 treatments per year, whereas over-the-counter items and meal benefits are available with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved