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 San Joaquin 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 annual prescription drug deductible. During the initial coverage phase, tier 1 preferred generic drugs are available with no copay at preferred pharmacies and preferred mail-order services, while standard locations charge a $10 copay. Tier 2 standard generics require a $42 copay at preferred locations and a $47 copay at standard locations, whereas tier 3 preferred brands and tier 4 non-preferred drugs require a 35% and 30% coinsurance, respectively. After your yearly out-of-pocket drug costs reach $2,100, 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 costs reduced to $0. You should check the plan's formulary to verify the coverage and tier placement of your specific medications.

Additional Benefits

Sutter Senior Advantage, a SCAN Medicare Plan (HMO), offers comprehensive coverage with predictable copays and no coinsurance for many essential services. For inpatient hospital stays, you will pay a $190 daily copay for days 1 through 5 and no copay for days 6 through 90, while emergency room visits require a $90 copay that is waived if you are admitted. Routine doctor visits and Medicare-covered preventive services, including annual physicals, are available with no copay and no coinsurance. The plan also features dental and vision benefits, including a routine eye exam with no deductible and a $200 annual allowance for eyewear, alongside preventive dental care. For specialized needs, skilled nursing facility stays have no copay for the first 20 days, and diagnostic services have no copay, though dialysis requires a 20% coinsurance. Additionally, members can take advantage of a $25 quarterly over-the-counter allowance and post-hospitalization meal benefits.