A non-government entity
SCAN Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Classic (HMO) in 2026, please refer to our full plan details page.
SCAN Classic (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2026 to people living in Sacramento, Placer, Yolo and San Joaquin Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that SCAN Classic (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 Classic (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 Classic (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 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 $2000.00 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:
Sign up for SCAN Classic (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The SCAN Classic (HMO) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $250.00. After meeting this deductible, you pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, while standard pharmacies and standard mail orders charge a $10.00 copay. Tier 2 standard generics cost a $42.00 copay at preferred locations and a $47.00 copay at standard locations, whereas Tier 3 preferred brands require 35% coinsurance and Tier 4 non-preferred drugs require 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, if you qualify for the low-income subsidy, your Part D cost-sharing under this plan is reduced to $0.00.
Additional Benefits
The SCAN Classic (HMO) plan offers comprehensive coverage for essential medical services with predictable cost-sharing, featuring no coinsurance for inpatient stays, outpatient services, and emergency care. Inpatient hospital stays require a $50 daily copay for the first five days and no copay for days six through 90, while emergency visits have a $90 copay that is waived upon admission. Additionally, urgent care, primary care visits, and Medicare-covered preventive services are available with no copay to help keep routine healthcare costs low. This plan also includes valuable supplemental benefits, such as a $250 annual vision allowance and up to $3,000 in dental coverage. Members benefit from no copay for up to 18 one-way transportation trips to plan-approved locations and a $110 quarterly over-the-counter allowance. Prescription hearing aids are covered with copays ranging from $550 to $850, alongside one routine yearly hearing exam and eyewear coverage with no deductible.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by SCAN Classic (HMO) and require prior authorization and a doctor referral. Covered acute and psychiatric stays require a $50 copay per day for days 1 through 5, no copay for days 6 through 90, and no coinsurance, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN Classic (HMO) with no coinsurance, featuring a $75 copay for outpatient hospital and ambulatory surgical center services, and a $5 copay for outpatient substance abuse sessions. Outpatient blood services are also covered with no deductible, though most of these services require a doctor referral and prior authorization.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization benefits with a $55 copay and no coinsurance. Prior authorization and a doctor referral are required for these services.
Ambulance and Transportation Services See details
SCAN Classic (HMO) covers ground and air ambulance services with a $150 copay and no coinsurance, though prior authorization is required. Transportation services are partially covered, providing up to 18 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
SCAN Classic (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, while worldwide emergency services and transportation are covered with copays of $90 and $150, respectively, and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by SCAN Classic (HMO), with no coverage provided for podiatry services and routine chiropractic care. Covered services such as occupational, physical, psychiatric, mental health, and opioid treatment therapies require a $5 copay and no coinsurance, while other covered services require no copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by SCAN Classic (HMO), which provides Medicare-covered zero-dollar preventive services with no copay and no coinsurance, as well as annual physical exams and kidney disease education. However, several sub-services are not covered under this plan, including in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional smoking cessation sessions, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling services.
Hearing Services See details
SCAN Classic (HMO) partially covers hearing services, offering one routine hearing exam per year and unlimited fitting evaluations with no deductible. Prescription hearing aids are covered up to two per year with a copay of $550 to $850 and no coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
SCAN Classic (HMO) offers partially covered vision services with no deductible, including one routine eye exam and a combined $250 annual allowance for eyeglasses or contact lenses. Prior authorization and doctor referrals are required for coverage, and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered under SCAN Classic (HMO), which includes preventive care and advanced treatments like restorative and implant services up to a $3,000 annual limit, though orthodontics is not covered. Copay and coinsurance details are not specified in the plan information, and prior authorization is required for several covered services.
Home Infusion bundled Services See details
SCAN Classic (HMO) covers Home Infusion bundled Services with prior authorization, which may require step therapy. Covered Medicare Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Classic (HMO) with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical Equipment is partially covered by SCAN Classic (HMO), offering durable medical equipment, prosthetic devices, and medical supplies with no copay and ranging from no coinsurance to 20% coinsurance. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered, and prior authorization is required for covered benefits.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under SCAN Classic (HMO), though diagnostic procedures, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services range from no copay to a $50 copay with no coinsurance, while therapeutic radiological services require a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by SCAN Classic (HMO), requiring both prior authorization and a doctor referral to access care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the SCAN Classic (HMO) plan; although the plan notes some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
SCAN Classic (HMO) partially covers Skilled Nursing Facility (SNF) services, which require a doctor referral and prior authorization. Stays feature no coinsurance, with no copay for days 1 to 20 and a $50 daily copay for days 21 to 100, though additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
SCAN Classic (HMO) partially covers Other Services, as acupuncture and dual eligible SNP services are not covered. Covered benefits include a meal benefit and a $110 quarterly over-the-counter allowance, both offered with no copay or coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved