Sutter Senior Advantage, a SCAN Medicare Plan (HMO)

Sutter Senior Advantage, a SCAN Medicare Plan (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2026 to people living in Stanislaus County. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Sutter Senior Advantage, a SCAN Medicare Plan (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 Sutter Senior Advantage, a SCAN Medicare Plan (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.

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:

Drug Coverage

The Sutter Senior Advantage, a SCAN Medicare Plan (HMO) features an enhanced alternative drug benefit with a $250 prescription drug deductible. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, while standard pharmacies and mail options charge a $10 copay. Tier 2 standard generic drugs require a $42 copay at preferred locations and a $47 copay at standard locations. For higher-tier medications, you will pay a 35% coinsurance for Tier 3 preferred brands and a 30% coinsurance for Tier 4 non-preferred drugs across all pharmacy types. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Individuals who qualify for the low-income subsidy can also benefit from reduced drug costs, paying $0 for Part D.

Additional Benefits

Sutter Senior Advantage, a SCAN Medicare Plan (HMO) offers comprehensive healthcare coverage with low out-of-pocket costs, featuring no copay to a $10 copay for primary care and specialist visits. Inpatient hospital stays require a $350 daily copay for the first six days and no copay thereafter, while outpatient hospital services carry a $250 copay with no coinsurance. Emergency care is available for a $90 copay, which is waived if you are admitted, and urgently needed services require no copay. The plan also includes routine vision and dental preventive services with no copay, alongside routine hearing exams for a $10 copay and prescription hearing aid coverage. Skilled nursing facility stays have no copay for the first 20 days, followed by a $160 daily copay for days 21 through 100. While diagnostic radiology and medical equipment are partially covered, cardiac rehabilitation services are not covered under this plan.