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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 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 Alameda and San Mateo 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 $1999.00 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 offers an Enhanced Alternative drug benefit with a $250 prescription drug deductible. Once this deductible is met, you will have no copay for Tier 1 preferred generic drugs, whether filled at a retail pharmacy or through mail order. For Tier 2 standard generic drugs, you will pay a copay of either $42 or $43 depending on the pharmacy you choose. For Tier 3 preferred brand drugs, you will pay a 35% coinsurance, while Tier 4 non-preferred drugs require a 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, those who qualify for the low-income subsidy can reduce their Part D costs to $0.
Additional Benefits
The SCAN MyChoice (HMO) plan offers comprehensive coverage for essential medical services, featuring no copays for urgent care, preventive visits, and the first 20 days of skilled nursing facility stays. For inpatient hospital stays, members pay a $150 daily copay for days 1 through 5, with no copay for days 6 through 90. Outpatient hospital visits require a $150 copay, while emergency room services have a $90 copay that is waived if you are admitted. This plan also provides valuable supplemental benefits, including routine hearing and vision exams with no copay, a $215 quarterly eyewear allowance, and covered dental care. Members can access acupuncture for a $5 copay, alongside over-the-counter items and meal benefits with no copay or coinsurance. For durable medical equipment and dialysis services, the plan features no copay and up to 20% coinsurance.
Inpatient Hospital See details
SCAN MyChoice (HMO) partially covers inpatient hospital services, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute care requires a $150 daily copay for days 1-5 and no copay for days 6-90, while psychiatric care requires a $200 daily copay for days 1-5 and no copay for days 6-90, both with no coinsurance.
Outpatient Services See details
Outpatient services are covered by SCAN MyChoice (HMO) with no coinsurance, featuring a $150 copay for outpatient hospital services and a $50 copay for ambulatory surgical center visits. Outpatient substance abuse sessions require a $10 copay, and outpatient blood services are covered with no deductible, no copay, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by SCAN MyChoice (HMO), though prior authorization and a doctor referral are required. Specific copay and coinsurance costs for these services are not detailed in the plan's benefit summary.
Ambulance and Transportation Services See details
SCAN MyChoice (HMO) partially covers ambulance and transportation services, offering ground and air ambulance services for a $105 copay and no coinsurance. Transportation services to plan-approved health-related locations and 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 have no copay and no coinsurance, while worldwide emergency services feature a $90 copay for emergency care and a $105 copay for emergency transportation, both with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by SCAN MyChoice (HMO), as podiatry services are not covered. Covered services require no coinsurance, featuring a $5 copay for routine chiropractic care and a $10 copay for mental health, psychiatric, and opioid treatment sessions.
Preventive Services See details
Preventive services are partially covered under the SCAN MyChoice (HMO) plan with no copay for Medicare-covered zero-dollar preventive services, annual physical exams, and kidney disease education. While some supplemental benefits like health education and fitness programs are included, several sub-services are not covered, including in-home safety assessments, medical nutrition therapy, weight management programs, and alternative therapies. Prior authorization and doctor referrals are required for certain covered services.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), which provides routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered with a copay of $550 to $850 and no coinsurance for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by SCAN MyChoice (HMO), providing one annual routine eye exam and a $215 combined eyewear allowance every three months with no deductible, though eyewear upgrades are not covered. Prior authorization and referrals are required for coverage, and no copay or coinsurance information is specified in the plan terms.
Dental Services See details
Dental services are partially covered by SCAN MyChoice (HMO), as orthodontics is not covered. Covered benefits include preventive care, Medicare-covered dental services requiring prior authorization, and orthodontic services which are capped at a maximum benefit of $215 every three months.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SCAN MyChoice (HMO) with prior authorization, featuring no copay and up to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are also covered under this benefit with a $35 copay and up to 20% coinsurance, with no minimum coinsurance required.
Dialysis Services See details
SCAN MyChoice (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment is partially covered by SCAN MyChoice (HMO), offering covered durable medical equipment, prosthetic devices, and medical supplies with no copay and a coinsurance ranging from no coinsurance to 20%. Under this plan, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under SCAN MyChoice (HMO), requiring prior authorization and a doctor referral for covered services. Therapeutic radiological services are covered with a $60 copay and no coinsurance, while diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by SCAN MyChoice (HMO), providing essential care to members in their homes. To access this benefit, both a doctor referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN MyChoice (HMO) plan. This non-coverage applies to all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $75 daily copay for days 21 through 100. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN MyChoice (HMO), featuring acupuncture for a $5 copay and no coinsurance, as well as over-the-counter items and meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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