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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 Fresno, Madera, Kings and Tulare 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 $1199.00 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) Medicare Advantage plan features an Enhanced Alternative drug benefit with a $250 annual prescription drug deductible. Once you meet this deductible, you will pay no copay for Tier 1 preferred generic drugs, whether using standard, preferred, or mail-order pharmacies. For Tier 2 standard generic drugs, you will pay a $42 copay at preferred pharmacies and preferred mail services, or a $43 copay at standard pharmacies and standard mail services. Tier 3 preferred brand drugs require a 35% coinsurance, while Tier 4 non-preferred drugs have a 30% coinsurance across all pharmacy options. After 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. If you qualify for the low-income subsidy, your Part D cost-share is reduced to $0.
Additional Benefits
The SCAN MyChoice (HMO) plan offers robust coverage for essential medical services with minimal out-of-pocket costs, featuring no deductibles and no coinsurance on most core benefits. Inpatient hospital stays require no copay for the majority of your stay, though a $100 daily copay applies for days four through seven. Outpatient hospital services range from no copay to a $100 copay, while emergency room visits carry a $90 copay that is waived if you are admitted. For everyday wellness, the plan features no copays for Medicare-covered preventive services, annual physicals, routine hearing exams, and annual vision exams. Members also benefit from a $240 eyewear allowance every three months, routine chiropractic and acupuncture visits for a low $5 copay, and dental coverage for exams and cleanings. While prescription hearing aids require a copay of $450 to $750, many other supplemental offerings like qualifying meals and over-the-counter items are available with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by SCAN MyChoice (HMO) with no coinsurance, though prior authorization and doctor referrals are required. For acute stays, there is no copay for days 1-3 and 8-90 and a $100 daily copay for days 4-7, while psychiatric stays require a $120 daily copay for days 1-10 and no copay for days 11-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN MyChoice (HMO) with no coinsurance, featuring a copay of $0 to $100 for outpatient hospital services and no copay for ambulatory surgical center services. Outpatient substance abuse services require a $20 copay per session with no coinsurance, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
SCAN MyChoice (HMO) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by SCAN MyChoice (HMO). Ground and air ambulance services are covered with a $75 copay and no coinsurance, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
SCAN MyChoice (HMO) covers emergency services with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services are covered with no copay or coinsurance, and worldwide emergency and transportation services are available with no coinsurance and copays ranging from $75 to $90.
Primary Care See details
SCAN MyChoice (HMO) covers primary care, telehealth, and therapy services, while podiatry, mental health specialty, and psychiatric services are not covered. Routine chiropractic care is covered with a $5 copay per visit for up to 20 visits per year, and opioid treatment services require a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by SCAN MyChoice (HMO) with no copay and no coinsurance for Medicare-covered preventive care. Covered services include annual physical exams and fitness benefits, while several sub-services such as weight management, alternative therapies, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), offering routine hearing exams and fitting evaluations with no deductible, no copays, and no coinsurance. The plan covers up to two prescription hearing aids (all types) per year with a copay of $450 to $750 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by SCAN MyChoice (HMO), providing one routine eye exam annually and a $240 combined eyewear allowance every three months with no deductibles. Eyewear upgrades are not covered under this plan.
Dental Services See details
SCAN MyChoice (HMO) partially covers dental services, including exams, cleanings, and select orthodontic services, though orthodontics is not covered. Copay and coinsurance costs are not specified in the plan details, but orthodontic services are subject to a maximum benefit of $240 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 no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
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) with no copay and coinsurance ranging from 0% to 20%, although diabetic supplies are not covered. Prior authorization is required for covered items such as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by SCAN MyChoice (HMO), with only therapeutic radiological services covered with no copay and a 20% coinsurance. Diagnostic procedures and tests, 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 MyChoice (HMO) plan, though prior authorization and a doctor referral are required. Specific copay and coinsurance costs are not detailed in the plan's service summary.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN MyChoice (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by SCAN MyChoice (HMO) with no copay for days 1 to 20 and a $50 daily copay for days 21 to 100, with no coinsurance. While prior authorization and a doctor referral are required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN MyChoice (HMO), as Dual Eligible SNPs with Highly Integrated Services are not covered. Covered benefits include acupuncture with a $5 copay and no coinsurance for up to 20 treatments per year, alongside over-the-counter items and qualifying meal benefits with no copay or coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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