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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 San Diego County. 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 $375.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For preferred and standard generic drugs, you will pay a copay of $0.00 or $42.00, or $43.00 depending on the pharmacy. Preferred and non-preferred brands will cost 50% and 33% coinsurance, respectively. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The SCAN MyChoice (HMO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, with costs differing based on the type of care and the number of days. Outpatient services, including substance abuse treatment, have copays, while services like primary care, vision, and home health have no copay. The plan also includes coverage for hearing services, dental services, medical equipment, and diagnostic services, each with its own specific copays or coinsurance. Emergency, ambulance, and skilled nursing facility services are covered with copays, while additional benefits such as acupuncture, over-the-counter items, and a meal benefit are also included.
Inpatient Hospital See details
The SCAN MyChoice (HMO) plan covers inpatient hospital stays, including acute and psychiatric care. For acute care, there is no copay for days 1-3 and 8-90, and a $50 copay for days 4-7; additional days are covered with no copay. For inpatient psychiatric care, there is a $120 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under this plan. Outpatient hospital services have a copay between $0 and $50, while individual and group sessions for outpatient substance abuse have a copay of $20.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN MyChoice (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN MyChoice (HMO) plan. Ground and Air Ambulance Services have a $75 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, and Worldwide Emergency Services are covered under the SCAN MyChoice (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $75 copay; there is no coinsurance for any of these services.
Primary Care See details
The SCAN MyChoice (HMO) plan covers Primary Care Physician Services, Chiropractic Services (with a limit of 30 visits per year), 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, but not Mental Health Specialty Services or Podiatry Services. Opioid Treatment Program Services have a copay of $20 per visit, while Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have no copay or coinsurance.
Preventive Services See details
The SCAN MyChoice (HMO) plan covers preventive services, including annual physical exams, health education, in-home support services, support for caregivers, fitness benefits, and remote access technologies. However, it does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing services are covered by the SCAN MyChoice (HMO) plan, including hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered, with a copay between $550 and $850 per year. Prescription hearing aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and 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. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $300 per year. However, upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers various 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, 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 has a copay between $0 and $140. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN MyChoice (HMO) plan, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor's referral. The copay for these services is $30.
Medical Equipment See details
Medical Equipment is covered by SCAN MyChoice (HMO), including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The SCAN MyChoice (HMO) plan covers some diagnostic and radiological services, but 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, and Medicare-covered X-Ray Services also have a copay.
Home Health Services See details
Home Health Services are covered by SCAN MyChoice (HMO), with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the specific sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor referral. For days 1-20, there is no copay, while days 21-100 have a $50 copay; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for SCAN MyChoice (HMO) includes acupuncture with prior authorization, and is limited to 30 treatments per year, as well as over-the-counter (OTC) items, with a $75 maximum benefit every three months. The plan also offers a meal benefit and some services are not covered.
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