A non-government entity
SCAN Allied (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Allied (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Allied (HMO) in 2026, please refer to our full plan details page.
SCAN Allied (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in San Francisco 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 Allied (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 Allied (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 Allied (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 Allied (HMO) Medicare prescription drug plan features an Enhanced Alternative benefit type with a $250 annual prescription drug deductible. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs across all pharmacy and mail-order options. For Tier 2 standard generics, copays range from $42 to $43, while Tier 3 preferred brands require a 35% coinsurance and 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 Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy will see their Part D costs reduced to $0. Be sure to check the plan's formulary to verify the coverage of your specific medications.
Additional Benefits
The SCAN Allied (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for inpatient hospital stays and outpatient services. For acute inpatient care, there is a $200 daily copay for the first five days and no copay for subsequent days, while emergency room visits carry a $90 copay that is waived upon admission. Additionally, the plan features no copay for urgently needed services, a $175 copay for ambulance transport, and up to 44 plan-approved one-way trips per year. Preventive care, routine hearing exams, and routine vision exams are available with no copays, alongside a $250 annual allowance for eyewear and up to $2,500 for covered dental services. Specialized care, such as mental health visits, requires a $15 copay, while prescription hearing aids carry a $550 to $850 copay with no coinsurance. The plan also includes a $155 quarterly over-the-counter allowance, though some services like cardiac rehabilitation and diabetic supplies are not covered under this plan.
Inpatient Hospital See details
SCAN Allied (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and doctor referrals for both acute and psychiatric stays. Acute care requires a $200 daily copay for days 1 to 5 and no copay for days 6 to 90 (excluding upgrades and non-Medicare stays), while psychiatric stays require a $900 copay per stay, with no coverage for additional days or non-Medicare-covered stays.
Outpatient Services See details
SCAN Allied (HMO) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $125 for outpatient hospital services and a $15 copay for outpatient substance abuse sessions. Prior authorization and a doctor referral are required for most outpatient care, including ambulatory surgical center and outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by SCAN Allied (HMO), though specific copay and coinsurance costs are not detailed in the plan information. To obtain coverage for this benefit, prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by SCAN Allied (HMO), as transportation to any health-related location is not covered. Medicare-covered ground and air ambulance services require prior authorization and carry a $175 copay and no coinsurance, while plan-approved transportation is covered for up to 44 one-way trips per year.
Emergency Services See details
SCAN Allied (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 coverage and transportation are available with copays of $90 and $175, respectively, and no coinsurance.
Primary Care See details
SCAN Allied (HMO) covers primary care, specialist, and telehealth services, while podiatry is not covered and chiropractic services are partially covered, excluding routine chiropractic care. Mental health, psychiatric, and opioid treatment services require a $15 copay and no coinsurance, with most specialized services requiring prior authorization and a doctor referral.
Preventive Services See details
Preventive services are partially covered by SCAN Allied (HMO) with no copay and no coinsurance for covered care, though some services require prior authorization or referrals. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, additional smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services offered by SCAN Allied (HMO) are partially covered, featuring routine hearing exams and fitting evaluations with no deductible, and prescription hearing aids (all types) with a $550 to $850 copay 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 Allied (HMO) partially covers vision services, offering one annual routine eye exam and eyewear, including contacts and eyeglasses, up to a $250 annual limit with no deductible. Eyewear upgrades are not covered under this plan, and specific copay or coinsurance details are not specified.
Dental Services See details
Dental Services are partially covered by SCAN Allied (HMO), as orthodontics is not covered under the plan. Covered benefits include oral exams, cleanings, and various restorative and surgical procedures with an annual orthodontic services limit of $2,500, though specific copay and coinsurance details are not specified.
Home Infusion bundled Services See details
SCAN Allied (HMO) covers Home Infusion bundled Services with prior authorization, featuring coinsurance ranging from no coinsurance to 20% and no copay for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs under this plan require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by SCAN Allied (HMO) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive this benefit.
Medical Equipment See details
Medical Equipment is partially covered by SCAN Allied (HMO) with no copay and coinsurance ranging from no coinsurance to 20% for durable medical equipment, prosthetics, and medical supplies. However, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Allied (HMO) with no copays. Therapeutic radiological services are covered with a 20% coinsurance and no copay, 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 under the SCAN Allied (HMO) plan, requiring both prior authorization and a doctor referral to receive care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Allied (HMO) plan, as all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN Allied (HMO), requiring prior authorization and a doctor referral. There is no copay or coinsurance for days 1 to 20, and a $75 copay with no coinsurance for days 21 to 100, but additional days beyond those covered by Medicare are not covered.
Other Services See details
SCAN Allied (HMO) partially covers other services, offering unlimited acupuncture, post-hospitalization meals, and a $155 quarterly over-the-counter allowance, while Dual Eligible SNPs with Highly Integrated Services are not covered. Specific copay and coinsurance details for these covered benefits are not specified in the plan terms.
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