A non-government entity
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 2026, 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 Los Angeles County. This plan received an overall rating of 4 out of 5 stars in 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $130.00. You must continue to pay paying your reduced 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 $1500.00 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) Medicare plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $250.00. During the initial coverage phase, there is no copay for Tier 1 preferred generic drugs at both preferred and standard pharmacies or mail-order services. For Tier 2 standard generic drugs, you will pay a copay of $42.00 at preferred pharmacies and mail-order, or $43.00 at standard pharmacies and mail-order. For higher-tier medications, Tier 3 preferred brand drugs require a 35% coinsurance, while Tier 4 non-preferred drugs have a 30% coinsurance. After 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, beneficiaries who qualify for the low-income subsidy can see their Part D premium reduced to zero.
Additional Benefits
The SCAN Allied (HMO) plan offers robust coverage for core medical needs, featuring no copay for urgent care and preventive services, alongside a $90 copay for emergency visits which is waived upon admission. Primary care and specialist visits are covered, including mental health specialty visits for a $10 copay and no coinsurance. Inpatient hospital stays and skilled nursing facility care are also covered, though prior authorizations and doctor referrals are required. For additional wellness benefits, the plan provides comprehensive dental coverage up to a $2,500 annual limit, a routine eye exam with a $300 annual eyewear allowance, and prescription hearing aids for a $550 to $850 copay. Members also receive up to 30 one-way transportation trips per year to plan-approved locations and a $65 monthly allowance for over-the-counter items. However, some services like diabetic supplies, routine podiatry, and diagnostic lab tests are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by SCAN Allied (HMO), requiring prior authorization and doctor referrals for both acute and psychiatric stays. While unlimited additional acute care days are covered with no cost-sharing on the day of discharge, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN Allied (HMO) covers outpatient services, including hospital, ambulatory surgical center, blood, and substance abuse services, which generally require prior authorization and a doctor referral. Outpatient substance abuse sessions require a $10 copay and no coinsurance, while blood services have no deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN Allied (HMO), although specific copay and coinsurance costs are not detailed in the plan benefits. To access these covered services, prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under SCAN Allied (HMO), featuring a $100 copay and no coinsurance for ground and air ambulance services. Transportation benefits are partially covered, offering up to 30 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Allied (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted. Urgently needed services require no copay and no coinsurance, while worldwide emergency services and transportation are covered with copays of $90 and $100, respectively, and no coinsurance.
Primary Care See details
SCAN Allied (HMO) covers primary care, specialist, and therapy services, with mental health specialty visits requiring a $10 copay and no coinsurance. Chiropractic services are partially covered as routine chiropractic care is excluded, podiatry is not covered, and some psychiatric services are covered but individual and group psychiatric sessions are not.
Preventive Services See details
Preventive services are covered by SCAN Allied (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physical exams, and kidney disease education. Additional preventive benefits are partially covered, but sub-services such as personal emergency response systems, weight management, alternative therapies, therapeutic massage, and home safety assessments are not covered.
Hearing Services See details
SCAN Allied (HMO) partially covers hearing services, including routine exams, fitting evaluations, and up to two prescription hearing aids (all types) annually 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
Vision services are partially covered by SCAN Allied (HMO), which includes one routine eye exam and up to $300 annually for eyewear with no deductible, though upgrades are not covered. Prior authorization and doctor referrals are required for these services, and specific copay or coinsurance amounts are not specified.
Dental Services See details
Dental services are partially covered by SCAN Allied (HMO), offering preventive care and comprehensive treatments up to a $2,500 annual limit, though orthodontics is not covered. While copay and coinsurance details are not specified, prior authorization is required for most comprehensive services.
Home Infusion bundled Services See details
SCAN Allied (HMO) partially covers Home Infusion bundled Services, requiring prior authorization and excluding Part D home infusion drugs as a bundled mandatory supplemental benefit. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
SCAN Allied (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
SCAN Allied (HMO) partially covers Medical Equipment, offering coverage for Durable Medical Equipment (DME) with prior authorization, though copay and coinsurance details are not specified. However, several services are not covered under this plan, including prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Allied (HMO), with only Therapeutic Radiological Services being covered at a $50 copay and no coinsurance. Other services, such as diagnostic procedures and tests, lab services, diagnostic radiological services, and outpatient X-ray services, are not covered.
Home Health Services See details
SCAN Allied (HMO) covers home health services, requiring prior authorization and a doctor referral, though specific copay and coinsurance information is not provided.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under SCAN Allied (HMO), as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered. Consequently, there are no copays or coinsurance costs for these services under this plan.
Skilled Nursing Facility (SNF) See details
SCAN Allied (HMO) partially covers Skilled Nursing Facility (SNF) services, which require prior authorization and a doctor referral but do not require a prior three-day inpatient hospital stay. Additional days beyond Medicare-covered services are not covered.
Other Services See details
Other Services are partially covered under the SCAN Allied (HMO) plan, which excludes Dual Eligible SNPs with Highly Integrated Services. Covered benefits include unlimited acupuncture treatments, post-hospitalization meals, and a $65 monthly allowance for over-the-counter items.
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