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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 San Francisco County. 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 $1999.00 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 an annual prescription drug deductible of $250.00. During the initial coverage phase, you will pay no copay for Tier 1 preferred generic drugs whether you use a preferred pharmacy, standard pharmacy, or mail-order service. For Tier 2 standard generic drugs, your copayment is $42.00 at preferred pharmacies and preferred mail order, or $43.00 at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 35% coinsurance, while Tier 4 non-preferred drugs require a 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy will benefit from a reduced Part D cost of $0.00.
Additional Benefits
The SCAN MyChoice (HMO) plan offers robust core medical coverage with predictable cost-sharing, featuring a $200 copay for days 1 to 5 of inpatient hospital stays (and no copay for days 6 to 90) alongside no copay for urgent care. Outpatient hospital services require a $175 copay, while emergency room visits carry a $90 copay that is waived if you are admitted. Routine preventive care has no copay, and physical, occupational, and speech therapy services require a low $15 copay. For supplemental care, the plan includes valuable dental, vision, and hearing benefits, featuring routine hearing exams with no copay and a $210 eyewear allowance. Members also enjoy over-the-counter items and meal benefits with no copay, alongside skilled nursing facility stays that feature no copay for the first 20 days. These comprehensive offerings ensure that your essential health and wellness needs are covered with minimal out-of-pocket costs.
Inpatient Hospital See details
SCAN MyChoice (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $200 copay for days 1-5 (no copay for days 6-90) for acute care and a $900 copay for psychiatric stays. Upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under SCAN MyChoice (HMO) are covered with no coinsurance, including outpatient hospital services for a $175 copay and ambulatory surgical center services for a $150 copay. Outpatient substance abuse sessions require a $10 copay 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 $25 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by SCAN MyChoice (HMO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground and air ambulance services require prior authorization and carry a $175 copay with no coinsurance.
Emergency Services See details
Emergency services are covered by SCAN MyChoice (HMO) with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services are available with no copay and no coinsurance, while worldwide emergency coverage has a $90 copay and worldwide emergency transportation has a $175 copay, both with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by SCAN MyChoice (HMO), as podiatry services are not covered. Covered services require no coinsurance, featuring copays of $5 for routine chiropractic care, $10 for mental health, psychiatric, and opioid treatment, and $15 for physical, occupational, and speech therapy.
Preventive Services See details
Preventive services are partially covered by SCAN MyChoice (HMO), which features no copay and no coinsurance for Medicare-covered zero-dollar preventive services. Uncovered services under this plan include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation counseling, enhanced disease management, telemonitoring, home/bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN MyChoice (HMO), featuring routine hearing exams and fitting evaluations with no copay, coinsurance, or deductible. Prescription hearing aids (all types) are covered up to two times per year with a $550 to $850 copay and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by SCAN MyChoice (HMO), featuring no deductibles for exams or eyewear but excluding eyewear upgrades from coverage. The plan includes one routine eye exam per year and a $210 combined eyewear allowance every three months, though specific copay and coinsurance terms are not specified.
Dental Services See details
SCAN MyChoice (HMO) partially covers dental services, including preventive care, comprehensive treatments, and Medicare-covered dental services, though orthodontic sub-services are not covered. Most covered services have no maximum benefit limit, but orthodontic services are capped at $210 every three months, and prior authorization is required for Medicare dental services.
Home Infusion bundled Services See details
SCAN MyChoice (HMO) covers home infusion bundled services with prior authorization required. Medicare Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN MyChoice (HMO) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical equipment is covered by SCAN MyChoice (HMO) with no copay and coinsurance ranging from no coinsurance to 20% for durable medical equipment, prosthetic devices, and medical supplies. For diabetic equipment, some services are covered, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
SCAN MyChoice (HMO) partially covers Diagnostic and Radiological Services, while diagnostic procedures, lab services, and outpatient X-rays are not covered. Covered diagnostic radiological services require a $50 copay and no coinsurance, whereas therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
SCAN MyChoice (HMO) covers home health services, though members must obtain a doctor referral and prior authorization to receive these benefits.
Cardiac Rehabilitation Services See details
SCAN MyChoice (HMO) does not cover Cardiac Rehabilitation Services, including intensive cardiac rehab, pulmonary rehab, and supervised exercise therapy (SET) for peripheral artery disease. Because these services are not covered by the plan, there is no copay or coinsurance for members.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by SCAN MyChoice (HMO) with no copay for days 1 to 20, a $125 daily copay for days 21 to 100, and no coinsurance. Prior authorization and a doctor referral are required, but additional days beyond Medicare-covered SNF care are not covered.
Other Services See details
Other Services are partially covered by the SCAN MyChoice (HMO) plan, with Dual Eligible SNPs with Highly Integrated Services being excluded from coverage. Covered benefits include acupuncture for a $5 copay and no coinsurance for up to 20 treatments per year, alongside over-the-counter items and meal benefits which both feature no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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