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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 Fresno and Madera 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 $999.00 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 no deductible for prescription drugs. During the initial coverage phase, you will pay different costs depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay, while standard generic drugs have a copay of $42-$43. For preferred brand drugs and non-preferred drugs, you will pay 50% and 33% coinsurance, respectively. Once 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 variety of benefits with varying costs. Hospital stays have copays depending on the length of stay, while outpatient services have copays between $0 and $85. Emergency services have a $90 copay. The plan also includes coverage for primary care with a $5 copay for routine chiropractic care, hearing services with copays for hearing aids, and vision services with no copay for routine eye exams. Dental services are covered with some limitations. Additionally, the plan covers home health services with no copay, and offers benefits for medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits under the SCAN MyChoice (HMO) plan include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has no copay for days 1-3 and days 8-90, with a $50 copay for days 4-7; additional days are covered with no copay. Inpatient Hospital Psychiatric has a $120 copay for days 1-10 and no copay for days 11-90. 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 all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $85, and individual and group sessions for outpatient substance abuse have a copay of $20.
Partial Hospitalization See details
Partial Hospitalization is covered under 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
The SCAN MyChoice (HMO) plan covers ambulance services with a $75 copay for both ground and air ambulance services, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Emergency Transportation are covered by the SCAN MyChoice (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, and Worldwide Emergency Transportation has a $75 copay, but 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 $5 copay for Routine Chiropractic Care, 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 with 20% coinsurance. Mental Health Specialty Services and Podiatry Services are not covered. Individual and Group Sessions for Mental Health and Psychiatric Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, health education, personal emergency response systems, fitness benefits, remote access technologies, in-home support services, and support for caregivers of enrollees. In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, 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 are covered, including hearing exams, routine hearing exams, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $450 and $750, but 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 MyChoice (HMO) plan covers routine eye exams with no copay, and covers eyewear, including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The SCAN MyChoice (HMO) plan covers a variety of dental services, including oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 visits per year), restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery; however, 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 by the SCAN MyChoice (HMO) plan. 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 by the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and Prosthetic Devices have a coinsurance between 0% and 20%, while Medical Supplies have a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
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 coinsurance of at most 20%, while Medicare-covered X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the SCAN MyChoice (HMO) plan with no copay and no 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 generally covered, but not covered by this plan. 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's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $50. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the "Other Services" benefit, SCAN MyChoice (HMO) covers acupuncture with a $5 copay and also covers over-the-counter items with a maximum benefit of $85 every three months, and a meal benefit. This plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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.
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