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SCAN Allied (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Allied (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Allied (HMO) in 2025, please refer to our full plan details page.
SCAN Allied (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in San Mateo County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SCAN Allied (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 Allied (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 Allied (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 $2200.00 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 Allied (HMO) plan has an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you'll pay no copay for preferred generic drugs, and $42-$43 for standard generic drugs. For preferred brand drugs, you pay 50% coinsurance, and for non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00.
Additional Benefits
The SCAN Allied (HMO) plan offers a wide range of benefits, including inpatient and outpatient hospital services with varying copays. Emergency, primary care, preventive, hearing, vision, and dental services are also covered, with some services having no copay. Additionally, the plan provides coverage for ambulance, transportation, and home health services, as well as medical equipment and home infusion services, and dialysis services with coinsurance. This plan includes additional benefits like cardiac rehabilitation, skilled nursing facility care, and certain other services such as acupuncture and over-the-counter items. However, it's important to note that some services, like podiatry and certain dental procedures, are not covered. Coverage for services like inpatient hospital stays, specialist visits, and hearing aids may have associated copays, so be sure to review the details.
Inpatient Hospital See details
The SCAN Allied (HMO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $175 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you'll pay a $250 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $125, and individual and group sessions for outpatient substance abuse each have a copay of $15.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $180 copay, and transportation services to a plan-approved health-related location with 36 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the SCAN Allied (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Worldwide Emergency Transportation has a $180 copay, with no coinsurance for any of these services. Worldwide Urgent Coverage is covered with no copay.
Primary Care See details
The SCAN Allied (HMO) plan covers Primary Care Physician Services, Chiropractic Services with a $10 copay, Occupational Therapy Services, Physician Specialist Services with a $10 copay, Mental Health Specialty Services with a $15 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits with a $0 - $10 copay, and Opioid Treatment Program Services with a $15 copay. The plan does not cover Podiatry Services.
Preventive Services See details
The SCAN Allied (HMO) plan covers preventive services including annual physical exams, health education, support for caregivers of enrollees, fitness benefits, remote access technologies, kidney disease education, and other preventive services like glaucoma screening, diabetes self-management training, and barium enemas. However, in-home safety assessment, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services are covered by the SCAN Allied (HMO) plan, including routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $550 and $850, while hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The SCAN Allied (HMO) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum plan benefit coverage of $200. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The SCAN Allied (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. However, fluoride treatment, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, 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%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the SCAN Allied (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the SCAN Allied (HMO) plan, with Durable Medical Equipment (DME) covered with a coinsurance between 0% and 20%, and no copay. Prosthetics/Medical Supplies are covered with a coinsurance, and Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services have a copay of at most $60.
Home Health Services See details
Home Health Services are covered by SCAN Allied (HMO) with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the listed sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Allied (HMO) plan, but require prior authorization and a doctor's referral. You will have no copay for days 1-20, and a $75 copay 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
The SCAN Allied (HMO) plan covers acupuncture with prior authorization, and it has no copay. The plan also covers over-the-counter (OTC) items with a maximum benefit coverage amount of $155 every three months, including nicotine replacement therapy and Naloxone. Meal benefits are covered with prior authorization. However, 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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