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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 Santa Clara and Stanislaus 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 $1299.00 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 offers an Enhanced Alternative drug benefit with a yearly prescription drug deductible of $250. Once you meet this deductible, you will pay no copay for Tier 1 preferred generic drugs at both preferred and standard pharmacies. For Tier 2 standard generic drugs, you will pay a $42 copay at preferred pharmacies and mail-order, or a $43 copay at standard pharmacies and mail-order. For higher-tier medications, Tier 3 preferred brands require a 35% coinsurance and Tier 4 non-preferred drugs require a 30% coinsurance. These initial coverage rates apply until your total drug costs reach $2,100, at which point you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, qualifying for the low-income subsidy can reduce your Part D premium to $0.
Additional Benefits
The SCAN MyChoice (HMO) plan offers robust medical coverage with predictable costs, featuring no coinsurance for inpatient hospital stays and a low $50 daily copay for the first three days. Outpatient services also feature no coinsurance, with no copay for ambulatory surgical centers and a $90 copay for emergency room visits that is waived upon admission. Additionally, skilled nursing facility stays require no copay for the first 20 days, followed by a $50 daily copay for days 21 through 100. For everyday health, this plan provides preventive care and routine eye exams with no copay, along with a $245 quarterly eyewear allowance and prescription hearing aids starting at a $550 copay. While cardiac rehabilitation and transportation services are not covered, members benefit from acupuncture sessions for a $5 copay and over-the-counter items with no copay or coinsurance. Medical equipment and Part B drugs generally carry no copay and a coinsurance of up to 20 percent.
Inpatient Hospital See details
SCAN MyChoice (HMO) provides partial coverage for inpatient hospital services with no coinsurance, as upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered. Covered acute stays require a $50 daily copay for days 1 to 3 (with no copay for days 4 to 90), while psychiatric stays require a $75 daily copay for days 5 to 10 (with no copay for days 1 to 4 and 11 to 90).
Outpatient Services See details
SCAN MyChoice (HMO) covers outpatient services with no coinsurance, though prior authorization and doctor referrals are required for most care. There is no copay for ambulatory surgical center services, a $0 to $100 copay for outpatient hospital services, a $10 copay for outpatient substance abuse sessions, and no deductible for blood services.
Partial Hospitalization See details
SCAN MyChoice (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization and a doctor referral are required to access these covered benefits.
Ambulance and Transportation Services See details
SCAN MyChoice (HMO) partially covers Ambulance and Transportation Services, offering ground and air ambulance services for a $95 copay and no coinsurance, with prior authorization required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by SCAN MyChoice (HMO) with a $90 copay and no coinsurance, and the copay is waived if you are admitted to the hospital. Urgently needed services have no copay and no coinsurance, while worldwide emergency coverage and worldwide emergency transportation require copays of $90 and $95 respectively, with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by SCAN MyChoice (HMO), as podiatry services are not covered. Most covered services require no coinsurance, with copays of $5 for routine chiropractic care and $10 for mental health, psychiatric, and opioid treatment sessions.
Preventive Services See details
Preventive services are partially covered by SCAN MyChoice (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, though some require prior authorization or referrals. Covered options include annual physicals and fitness benefits, while excluded sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, additional smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), offering routine hearing exams and fitting evaluations with no deductible, and up to two prescription hearing aids (all types) yearly for a $550 to $850 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
SCAN MyChoice (HMO) partially covers vision services with no deductible, though eyewear upgrades are not covered. The plan covers one routine eye exam per year and offers a $245 combined eyewear allowance every three months for contacts and eyeglasses, with prior authorization and doctor referrals required.
Dental Services See details
SCAN MyChoice (HMO) partially covers dental services, providing preventive care such as exams, cleanings, and x-rays, alongside unlimited restorative and surgical procedures, though orthodontics is not covered. While copay and coinsurance details are not specified, Medicare-covered dental requires prior authorization, and other orthodontic services have a maximum benefit of $245 every three months.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN MyChoice (HMO) and require prior authorization. Medicare Part B insulin drugs feature a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs have no copay and the same coinsurance range.
Dialysis Services See details
Dialysis Services are covered by SCAN MyChoice (HMO) with a 20% coinsurance and no copayment. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment benefits are partially covered by SCAN MyChoice (HMO), as diabetic supplies are not covered. Covered services, including durable medical equipment, prosthetics, and medical supplies, require no copay and coinsurance ranging from no coinsurance to 20%, while diabetic therapeutic shoes and inserts carry a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under SCAN MyChoice (HMO) are partially covered, requiring prior authorization and a doctor referral. For diagnostic services, some services are covered but diagnostic procedures, tests, and lab services are not covered in practice, while outpatient X-ray services are also uncovered. Covered diagnostic radiological services require no coinsurance and a $0 to $100 copay, while therapeutic radiological services carry a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered by the SCAN MyChoice (HMO) plan, requiring prior authorization and a doctor referral to access care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN MyChoice (HMO) plan, which includes intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN MyChoice (HMO) with no copay for days 1 to 20, a $50 daily copay for days 21 to 100, and no coinsurance. The benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, and prior authorization and a doctor referral are required.
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 for a $5 copay and no coinsurance (limited to 15 treatments per year), alongside over-the-counter items and 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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