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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 Alameda and San Mateo 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 $1500.00 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 no copay for preferred generic drugs, and a $42 copay at preferred pharmacies for standard generic drugs. For preferred brand drugs, you'll pay 50% coinsurance, and 33% coinsurance for non-preferred drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The SCAN MyChoice (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays between $0 and $125. Other services like ambulance, emergency, and primary care have copays, while many preventive services are covered. This plan also includes coverage for hearing aids with a copay, routine vision and dental services, and home infusion services with a copay or coinsurance. Additionally, there are benefits for medical equipment with coinsurance, and skilled nursing facilities with copays. Some other services, such as acupuncture and over-the-counter items, are covered with specific limitations.
Inpatient Hospital See details
Inpatient Hospital benefits with SCAN MyChoice (HMO) cover Inpatient Hospital-Acute with a $100 copay for days 1-5 and no copay for days 6-90, and Inpatient Hospital Psychiatric with a $200 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient Hospital Services have a copay between $0 and $125, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
For SCAN MyChoice (HMO), Ambulance and Transportation Services include coverage for ground and air ambulance services with a $105 copay, and no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by SCAN MyChoice (HMO). Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Worldwide Emergency Transportation has a $105 copay; there is no coinsurance for these services.
Primary Care See details
The SCAN MyChoice (HMO) plan covers primary care physician services, chiropractic services with a $5 copay for routine care up to 30 visits per year, occupational therapy services with no copay or coinsurance, physician specialist services, mental health specialty services with a $10 copay for individual and group sessions, psychiatric services with a $10 copay for individual and group sessions, physical therapy and speech-language pathology services with no copay or coinsurance, additional telehealth benefits, and opioid treatment program services with a $10 copay. Podiatry services are not covered.
Preventive Services See details
The SCAN MyChoice (HMO) plan covers preventive services, including annual physical exams and additional preventive services, with some services like In-Home Safety Assessment, Medical Nutrition Therapy, and others not covered. Health Education, Personal Emergency Response System, Fitness Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are 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 routine eye exams with no copay, and also covers eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $200 per year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 per year), restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. Orthodontic services have a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while 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. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the SCAN MyChoice (HMO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20% and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance, but no copay; the coinsurance applies to Medicare-covered Prosthetic Devices and Medicare-covered Medical Supplies. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
For SCAN MyChoice (HMO), some Diagnostic and Radiological Services are covered, 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 $60.00.
Home Health Services See details
Home Health Services are covered by SCAN MyChoice (HMO), with no copay or coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the 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 for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN MyChoice (HMO) with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $75. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the SCAN MyChoice (HMO) plan, acupuncture is covered with a $5 copay and a limit of 30 treatments per year, while over-the-counter items are covered up to $75 every three months, and meal benefits are also available. However, 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, and Self-Directed Personal Assistance Services are not covered.
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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