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Sutter Senior Advantage, a SCAN Medicare Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sutter Senior Advantage, a SCAN Medicare Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sutter Senior Advantage, a SCAN Medicare Plan (HMO) in 2026, please refer to our full plan details page.
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 Sacramento, Placer and Yolo Counties. 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.
For Sutter Senior Advantage, a SCAN Medicare Plan (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 $2500.00 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 Sutter Senior Advantage, a SCAN Medicare Plan (HMO) features an Enhanced Alternative drug benefit with a $250 prescription drug deductible. After meeting this deductible, members enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, compared to a $10 copay at standard pharmacies. Tier 2 standard generic drugs require a $42 copay at preferred locations and a $47 copay at standard locations. For higher-tier medications, members pay a 35% coinsurance for Tier 3 preferred brands and a 30% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, individuals who qualify for the low-income subsidy or Extra Help will pay nothing for their Part D drugs.
Additional Benefits
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) provides comprehensive medical coverage with predictable costs, featuring no copay for preventive services and a low $5 copay for primary care visits. Inpatient hospital stays require a $125 daily copay for the first 5 days and no copay thereafter, while emergency room visits have a $90 copay that is waived upon admission. Outpatient hospital services carry a $195 copay, and specialists generally require a $20 copay, all with no coinsurance. The plan also features valuable additional benefits, including dental care with a $20 copay, routine eye exams ranging from no copay to $20, and a $125 annual eyewear allowance. While routine hearing exams require a $20 copay, prescription hearing aids are covered with copays between $550 and $850. Members also benefit from a $30 quarterly over-the-counter allowance and a post-hospitalization meal program, both offered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO), with no coinsurance required. Acute stays require a $125 daily copay for days 1 to 5 and no copay for days 6 to 90, while psychiatric stays require a $120 daily copay for days 1 to 10 and no copay for days 11 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) covers outpatient services with no coinsurance, including a $195 copay for outpatient hospital services, a $75 copay for ambulatory surgical center services, and a $20 copay for outpatient substance abuse sessions. Outpatient blood services are also covered with no copay or deductible, though most outpatient services require prior authorization and a doctor referral.
Partial Hospitalization See details
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) covers partial hospitalization benefits with a $55 copay and no coinsurance. Prior authorization and a doctor referral are required to access these services.
Ambulance and Transportation Services See details
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) partially covers ambulance and transportation services, as transportation services to plan-approved or any health-related locations are not covered. Covered ground and air ambulance services require prior authorization and carry a $250 copay with no coinsurance.
Emergency Services See details
Sutter Senior Advantage, a SCAN Medicare Plan (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 require no copay or coinsurance, while worldwide emergency coverage and emergency transportation are covered with no coinsurance and copays of $90 and $250, respectively.
Primary Care See details
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) covers primary care physician visits with a $5 copay and no coinsurance. Other outpatient specialist, mental health, and therapy services generally require a $20 copay, while telehealth options range from no copay to $20, and podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO), featuring no copay or coinsurance for Medicare-covered zero-dollar preventive services, annual physical exams, and kidney disease education. Additional preventive benefits are partially covered, as memory fitness and remote access technologies are included, while sub-services such as weight management, alternative therapies, therapeutic massage, and in-home support are not covered.
Hearing Services See details
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) partially covers hearing services, as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered. Covered routine exams require a $20 copay and prescription hearing aids carry a $550 to $850 copay, with no deductibles or coinsurance required.
Vision Services See details
Vision services are partially covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO), as eyewear upgrades are not covered. The plan features a copay ranging from no copay up to $20 and no coinsurance for eye exams, alongside a $125 annual eyewear allowance with no deductible or coinsurance.
Dental Services See details
Dental services are covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO), with Medicare-covered dental care requiring a $20 copay and no coinsurance. Preventive care and periodontics are covered, but orthodontic services are only partially covered, excluding restorative services, endodontics, implants, prosthodontics, oral surgery, adjunctive general, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under Sutter Senior Advantage, a SCAN Medicare Plan (HMO), requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) partially covers medical equipment with no copays, though diabetic supplies are not covered. Covered durable medical equipment, prosthetics, and medical supplies range from no coinsurance to 20% coinsurance, while diabetic therapeutic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Sutter Senior Advantage, a SCAN Medicare Plan (HMO) partially covers Diagnostic and Radiological Services, as diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services require no coinsurance and a copay ranging from no copay up to $125, while therapeutic radiological services require a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO), though members must obtain prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Sutter Senior Advantage, a SCAN Medicare Plan (HMO). This lack of coverage applies to all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO), offering no copay or coinsurance for days 1 through 20 and a $125 daily copay with no coinsurance for days 21 through 100. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Sutter Senior Advantage, a SCAN Medicare Plan (HMO), as acupuncture and dual eligible SNP services are not covered. Covered benefits include a meal program after hospitalization and a $30 quarterly over-the-counter allowance, both provided with no copay or coinsurance.
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