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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 Santa Clara and Stanislaus 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 $1200.00 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 a $0 deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic drugs, and a $42 or $43 copay for standard generic drugs depending on the pharmacy. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you will enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The SCAN MyChoice (HMO) plan offers a comprehensive range of benefits with varying cost-sharing. Inpatient hospital stays have no copay for most days, but some days have a $75 copay. Outpatient services have copays up to $100. This plan includes coverage for primary care, preventive services, hearing, vision, and dental. Additional benefits include ambulance services with a $95 copay, emergency services with a $90 copay, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will have no copay for days 1-4 and 11-90, but a $75 copay for days 5-10. For Inpatient Hospital Psychiatric, you will have no copay for days 1-4 and 11-90, but a $75 copay for days 5-10. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered Stay 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 under this plan. Outpatient Hospital Services have a copay between $0 and $100, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $10.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN MyChoice (HMO) with a $55 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
The SCAN MyChoice (HMO) plan covers ambulance services, including both ground and air ambulance services, each with a $95 copay and 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 under the SCAN MyChoice (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, and Worldwide Emergency Transportation has a $95 copay; all have no coinsurance.
Primary Care See details
The SCAN MyChoice (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits and opioid treatment program services. Routine chiropractic care has a $5 copay, individual and group sessions for mental health and psychiatric services have a $10 copay.
Preventive Services See details
The SCAN MyChoice (HMO) plan covers preventive services, including annual physical exams, health education, personal emergency response systems, fitness benefits, remote access technologies, in-home support services, and support for caregivers of enrollees. Some preventive services, like in-home safety assessments, medical nutrition therapy, and several others, are not covered.
Hearing Services See details
The SCAN MyChoice (HMO) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $550 and $850. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
The SCAN MyChoice (HMO) plan covers vision services, including routine eye exams with no deductible or coinsurance, but requires prior authorization and a doctor referral. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum of $300 every two years, but upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0% and 20%. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment and Prosthetics/Medical Supplies, is covered under the SCAN MyChoice (HMO) plan. Durable Medical Equipment has a coinsurance of 0% to 20% and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, and Diabetic Equipment has a coinsurance, while Diabetic Supplies are not covered and Diabetic Therapeutic Shoes/Inserts have a coinsurance of 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with some services not covered. Diagnostic Radiological Services have a copay of up to $100, while Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services, Diagnostic Procedures/Tests, and Lab Services are not covered.
Home Health Services See details
Home Health Services are covered under the SCAN MyChoice (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 Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, while days 21-100 have a $50 copay; additional and non-Medicare-covered SNF days are not covered.
Other Services See details
Under the SCAN MyChoice (HMO) plan, acupuncture has a $5 copay, and over-the-counter (OTC) items are covered up to $40 every three months. The 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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