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SCAN Compass (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Compass (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Compass (HMO) in 2026, please refer to our full plan details page.
SCAN Compass (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2026 to people living in Alameda County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that SCAN Compass (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 Compass (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 Compass (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. 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 $4500.00 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 Compass (HMO) medicare plan features a $250 annual prescription drug deductible before the initial coverage phase begins. During this initial phase, you will enjoy no copay on tier 1 preferred generic drugs when using preferred pharmacies or preferred mail order services. For tier 2 standard generic drugs, copays are $42 at preferred locations and $47 at standard pharmacies. Higher-tier medications require coinsurance, with tier 3 preferred brand drugs costing 35% coinsurance and tier 4 non-preferred drugs requiring 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy can receive a premium reduction down to $0.
Additional Benefits
The SCAN Compass (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no coinsurance for many key medical services. For inpatient hospital stays, members pay a $300 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services require a $250 copay, primary care visits range from no copay to a $15 copay, and emergency room visits carry a $90 copay that is waived if admitted. This plan also includes dental, vision, and hearing benefits, with routine exams starting at no copay up to a $15 copay. Prescription hearing aids are covered with copays between $550 and $850, and members receive a $150 annual eyewear allowance alongside a $50 quarterly over-the-counter allowance with no copay. While home health services are covered, other services like dialysis and durable medical equipment require up to a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by SCAN Compass (HMO) with a $300 copay per day for days 1 through 5, no copay for days 6 through 90, and no coinsurance. While acute and psychiatric stays are covered with prior authorization and doctor referrals, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN Compass (HMO) covers outpatient services with no coinsurance, including outpatient hospital services for a $250 copay and ambulatory surgical center services for a $100 copay. Outpatient substance abuse sessions require a $15 copay, and outpatient blood services are covered with no deductible, though prior authorization and referrals are generally required.
Partial Hospitalization See details
SCAN Compass (HMO) covers partial hospitalization benefits with a $55 copay and no coinsurance. These services require prior authorization and a doctor referral.
Ambulance and Transportation Services See details
SCAN Compass (HMO) partially covers Ambulance and Transportation Services, offering ground and air ambulance services for a $250 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
SCAN Compass (HMO) covers emergency services with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services are covered with no copay and no coinsurance, and worldwide emergency services are covered with copays up to $250 and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by SCAN Compass (HMO), with copays ranging from no copay to $15.00 and no coinsurance for covered services. Podiatry services and routine chiropractic care are not covered under this plan.
Preventive Services See details
Preventive services are covered by SCAN Compass (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services, annual physicals, and kidney disease education. However, the benefit is only partially covered, excluding in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, home/bathroom safety, and counseling. Prior authorization and doctor referrals are required for several of the covered services.
Hearing Services See details
SCAN Compass (HMO) partially covers hearing services, offering routine hearing exams for a $15 copay and fitting evaluations with no copay, both with no coinsurance. Prescription hearing aids are covered up to twice a year with a copay ranging from $550 to $850 and no coinsurance, while OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
SCAN Compass (HMO) partially covers vision services, as eyewear upgrades are not covered. Covered eye exams require a $0 to $15 copay and no coinsurance, while eyewear is covered up to $150 annually with no copay or coinsurance, subject to prior authorization and doctor referrals.
Dental Services See details
Dental services are partially covered by SCAN Compass (HMO), featuring Medicare-covered dental care with a $15 copay and no coinsurance, alongside routine exams, cleanings, x-rays, fluoride, and periodontics. However, sub-services such as restorative care, endodontics, implants, prosthodontics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Compass (HMO) covers Home Infusion bundled Services with prior authorization, requiring a $35 copay and ranging from no coinsurance to 20% coinsurance for Medicare Part B insulin. Other covered Part B drugs, including chemotherapy and radiation, require no copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the SCAN Compass (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
SCAN Compass (HMO) covers durable medical equipment, prosthetic devices, and medical supplies with no copay and 0% to 20% coinsurance. 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 Compass (HMO) partially covers diagnostic and radiological services, though some diagnostic services are covered, diagnostic procedures, lab services, and outpatient x-rays are not. Covered diagnostic radiological services feature no coinsurance and a copay of $0 to $75, while therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home health services are covered by the SCAN Compass (HMO) plan, though prior authorization and a doctor referral are required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Compass (HMO) plan, as Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are all not covered.
Skilled Nursing Facility (SNF) See details
SCAN Compass (HMO) partially covers Skilled Nursing Facility (SNF) care with no copay for days 1 through 20, a $200 daily copay for days 21 through 100, and no coinsurance. Prior authorization and doctor referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by SCAN Compass (HMO), excluding acupuncture and dual eligible SNPs with highly integrated services. Covered benefits include a $50 quarterly over-the-counter allowance that carries forward and post-hospitalization meal benefits with prior authorization, both available with no copay or coinsurance.
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