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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 Los Angeles 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 $1000.00 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. The plan has a $0 deductible. During the initial coverage phase, you will pay no copay for preferred generic drugs. For standard generic drugs, you will pay a $42 copay at a preferred pharmacy and a $43 copay at a standard pharmacy. Preferred and standard brand drugs have a 50% coinsurance, and non-preferred drugs have a 33% coinsurance.
Additional Benefits
The SCAN Allied (HMO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a $50 copay for days 1-5 and no copay for days 6-90, and outpatient services, including substance abuse, have copays. Emergency services have a $140 copay, and ambulance services have a $100 copay. This plan includes coverage for primary care, hearing, vision, and dental services, with copays ranging from $10 to $850 for specific services, and a $300 annual maximum for eyewear. Medical equipment, home health, and acupuncture are covered with no copay. The plan also covers transportation, OTC items, and meals.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a $50 copay for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric is also covered, but Additional Days and Non-Medicare-covered Stay for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Individual and group sessions for outpatient substance abuse have a copay of $10.00.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN Allied (HMO) with a $10 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the SCAN Allied (HMO) plan. Ground and air ambulance services have a $100 copay, and transportation services to a plan-approved health-related location are covered for 32 one-way trips per year using rideshare services, bus/subway, or medical transport.
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, while Worldwide Emergency Transportation has a $100 copay, and Urgently Needed Services has no copay.
Primary Care See details
The SCAN Allied (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy with no copay or coinsurance, physician specialist services with a $10 copay, mental health specialty services with a $10 copay for individual and group sessions, and physical therapy and speech-language pathology services with no copay or coinsurance. The plan also covers additional telehealth benefits with a copay between $0 and $10, and Opioid Treatment Program Services with a $10 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, health education, support for caregivers, fitness benefits, remote access technologies, and kidney disease education services, are covered by the SCAN Allied (HMO) plan. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services with SCAN Allied (HMO) include routine hearing exams for a $10 copay, with a limit of one exam per year. Fitting/Evaluation for Hearing Aid is covered with no limit, and Prescription Hearing Aids (all types) are covered with a copay between $550 and $850, with a limit of 2 per year, while prescription hearing aids inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a $10 copay, while eyewear, including contact lenses, has a $10 copay and a combined maximum plan benefit of $300 per year.
Dental Services See details
The SCAN Allied (HMO) plan covers dental services with a $10 copay for Medicare dental services. Other covered dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. 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, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the SCAN Allied (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by SCAN Allied (HMO), including Durable Medical Equipment and Prosthetics/Medical Supplies, with no copay or coinsurance; however, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment is covered, but only from specified manufacturers.
Diagnostic and Radiological Services See details
The SCAN Allied (HMO) plan covers therapeutic radiological services with a copay of at most $50, but diagnostic procedures/tests, lab services, diagnostic radiological services, and outpatient X-ray services are not covered. All diagnostic and radiological services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the SCAN Allied (HMO) plan with no copay and no coinsurance; however, Additional Hours of Care and Personal Care Services are not covered. Authorization and referrals are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the SCAN Allied (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required.
Other Services See details
The SCAN Allied (HMO) plan covers acupuncture, Over-the-Counter (OTC) items, and a meal benefit. Acupuncture requires prior authorization and has no copay or coinsurance. OTC items have a maximum benefit of $200 every three months, and the plan offers nicotine replacement therapy and Naloxone coverage. The meal benefit also requires prior authorization. Several other services are not covered.
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