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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 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 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 $2400.00 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 no copay for preferred generic drugs, and $42-43 for standard generic drugs. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 33% coinsurance. After 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 range of benefits, including inpatient and outpatient hospital services with varying copays, and coverage for emergency services. Primary care, preventive services, hearing, vision, and dental services are also covered, with specific copays and limitations on certain services. Additionally, the plan provides coverage for ambulance, home health, dialysis, medical equipment, and diagnostic services. It also covers home infusion, cardiac rehabilitation, and skilled nursing facility services. However, some services, such as transportation to health-related locations, and certain hearing aids, dental procedures, and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $150 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, there is a $900 copay for a Medicare-covered stay. 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 include coverage for outpatient hospital services with a copay between $0 and $200, observation services, and ambulatory surgical center services with no copay, as well as outpatient substance abuse services, including individual and group sessions, each with a copay of $25.00. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the SCAN MyChoice (HMO) plan, with a $25 copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the SCAN MyChoice (HMO) plan. Both ground and air ambulance services have a $175 copay, with no coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, including 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, while Worldwide Emergency Transportation has a $175 copay, and 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, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $5 copay for routine care, and occupational therapy services, psychiatric services, and mental health specialty services have a $15-$25 copay. Physical therapy and speech-language pathology services have a $15 copay, and opioid treatment program services have a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero dollar preventive services, annual physical exams, and additional preventive services. Some services are covered, but the plan does not cover in-home safety assessments, medical nutrition therapy, 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 benefits, 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.
Hearing Services See details
Hearing services with SCAN MyChoice (HMO) include 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 per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
The SCAN MyChoice (HMO) plan covers vision services, including routine eye exams with no deductible, and eyewear with a combined maximum benefit of $300 every two years. This plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames with a limit of one pair or set every two years, but upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers various dental services, including oral exams and dental x-rays (limited to 2 per year), other diagnostic services with a copay of $0-$5, and prophylaxis (cleaning) with a limit of 2 per year. This plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics. Restorative services have a copay of $8-$395, adjunctive general services have a copay of $0-$125, endodontics has a copay of $5-$395, periodontics has a copay of $0-$380, prosthodontics (removable) has a copay of $13-$395, prosthodontics (fixed) has a copay of $25-$395, and oral and maxillofacial surgery has a copay of $0-$140.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0-20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by SCAN MyChoice (HMO), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance for Medicare-covered devices and supplies, with no copay. Diabetic Equipment requires prior authorization, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The SCAN MyChoice (HMO) plan covers Diagnostic and Radiological Services, but Diagnostic Procedures/Tests, Lab Services and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of at most $60, while Therapeutic Radiological Services have a coinsurance of at most 20%.
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. This benefit requires prior authorization and a referral.
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. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN MyChoice (HMO) with prior authorization and a doctor's referral. There is no copay for days 1-20, and a $125 copay per day for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under Other Services, acupuncture has a $5 copay, and the meal benefit is covered with prior authorization. Over-the-counter items, 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 are not covered.
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