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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 2025, 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 County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 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) plan has an Enhanced Alternative drug benefit. There is no deductible for prescription drugs with this plan. During the initial coverage phase, you will pay no copay for preferred generic drugs, while standard generic drugs have a $42 or $43 copay. For preferred and non-preferred brand drugs, you will pay 50% and 33% coinsurance, respectively. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The SCAN Allied (HMO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, with outpatient services and emergency services also having copays. Primary care, vision, dental, and hearing services are covered with copays for exams and services, and some plans also include coverage for ambulance, and transportation. This plan also provides additional benefits like home health services with no copay, and coverage for medical equipment and home infusion services. Preventive services are covered with no copay, and there are also benefits for over-the-counter items and meal benefits. The plan also has additional benefits for specialized services such as cardiac rehabilitation, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $200 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a $900 copay. Additional days and upgrades for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays are not covered for either.
Outpatient Services See details
Outpatient Services are covered by SCAN Allied (HMO), including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $200, Ambulatory Surgical Center Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $15.
Partial Hospitalization See details
Partial Hospitalization is covered by the SCAN Allied (HMO) plan, with a $25 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the SCAN Allied (HMO) plan, with a $175 copay for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 36 one-way trips per year using rideshare services, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Transportation are covered by the SCAN Allied (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Worldwide Emergency Transportation has a $175 copay. Worldwide Urgent Coverage is also covered, but there is no information about cost sharing.
Primary Care See details
The SCAN Allied (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy with a $15 copay, physician specialist services with a $10 copay, mental health specialty services with a $15 copay, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a $0-$10 copay, and opioid treatment program services with a $15 copay; however, routine chiropractic care and podiatry services are not covered. Prior authorization and a doctor referral are required for chiropractic, occupational, and psychiatric services, and for physical therapy and speech-language pathology services.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, annual physical exams, health education, support for caregivers, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services under the SCAN Allied (HMO) plan include routine hearing exams with a $10 copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $550 and $850. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The SCAN Allied (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a $10 copay, and eyewear has a $10 copay with a combined maximum benefit of $150 every year for contact lenses.
Dental Services See details
The SCAN Allied (HMO) plan offers dental services with a $10 copay for Medicare dental services. Other services include oral exams (2 visits per year), dental X-rays (1 per year), other diagnostic dental services, and prophylaxis (cleaning) (2 per year). Fluoride treatment, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, and orthodontics are not covered. Orthodontic services are covered up to $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the SCAN Allied (HMO) plan. A doctor referral and prior authorization are required. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, are covered by the SCAN Allied (HMO) plan. For Durable Medical Equipment, there is a coinsurance of 0% to 20% and no copay. Prosthetic Devices have a coinsurance of 0% to 20% and no copay, while Medical Supplies have a 0% to 20% coinsurance and no copay. However, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the SCAN Allied (HMO) plan. While diagnostic procedures/tests, lab services, and outpatient X-Ray services are not covered, Diagnostic Radiological Services have a copay of at most $60.00, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the SCAN Allied (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following sub-services: 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 under the SCAN Allied (HMO) plan, but require prior authorization and a doctor referral. For days 1-20, there is no copay, and for days 21-100, the copay is $75.
Other Services See details
The SCAN Allied (HMO) plan covers acupuncture, over-the-counter items, and a meal benefit. Acupuncture requires prior authorization and is unlimited. Over-the-counter items are covered up to $155 every three months, and include nicotine replacement therapy and Naloxone. The meal benefit is available after surgery or inpatient hospitalization, or for a medical condition that requires the enrollee to remain at home for a period of time, and requires prior authorization. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and more are not covered.
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