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SCAN Balance (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Balance (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Balance (HMO C-SNP) in 2026, please refer to our full plan details page.
SCAN Balance (HMO C-SNP) is a HMO C-SNP 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 Balance (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
SCAN Balance (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about SCAN Balance (HMO C-SNP).
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 Balance (HMO C-SNP), 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:
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Drug Coverage
The SCAN Balance (HMO C-SNP) plan offers an Enhanced Alternative prescription drug benefit with an annual deductible of $250.00. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs when using preferred pharmacies or preferred mail order, while standard locations require a $10.00 copay. Tier 2 standard generic drugs cost a $42.00 copay at preferred locations and a $47.00 copay at standard locations. For higher-tier medications, you will pay 35% coinsurance for Tier 3 preferred brand drugs and 30% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, qualifying for the Extra Help low-income subsidy can reduce your Part D premium to $0.00.
Additional Benefits
The SCAN Balance (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, specialist, and telehealth visits. For inpatient hospital stays, members pay a $50 daily copay for days 1 through 5 and no copay for days 6 through 90. Outpatient hospital services require a $75 copay, while emergency room visits carry a $90 copay that is waived if you are admitted. This plan also provides valuable supplemental benefits, including dental care up to a $3,000 annual limit and vision coverage with no deductible and a $250 annual eyewear allowance. Routine hearing exams are available with no deductible, and prescription hearing aids require a copay of $550 to $850. Additionally, members receive a $35 monthly allowance for over-the-counter items and up to 26 one-way trips per year for plan-approved transportation.
Inpatient Hospital See details
SCAN Balance (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with a $50 daily copay for days 1 to 5, no copay for days 6 to 90, and no coinsurance. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN Balance (HMO C-SNP) covers outpatient hospital and ambulatory surgical center services with a $75 copay and no coinsurance. Outpatient substance abuse sessions require a $5 copay and no coinsurance, while outpatient blood services are covered with no deductible, copay, or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by SCAN Balance (HMO C-SNP) with a $55 copay and no coinsurance. Prior authorization and a doctor referral are required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by SCAN Balance (HMO C-SNP), though transportation is only partially covered because trips to any health-related location are not covered. Ground and air ambulance services require prior authorization and have a $150 copay and no coinsurance, while plan-approved transportation is covered for up to 26 one-way trips per year.
Emergency Services See details
SCAN Balance (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, which is 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 offered with no coinsurance and copays of $90 and $150, respectively.
Primary Care See details
SCAN Balance (HMO C-SNP) covers primary care, specialist, and telehealth services with no copay and no coinsurance, while occupational, physical, mental health, psychiatric, and opioid treatment services require a $5 copay and no coinsurance. Chiropractic services are partially covered, with routine chiropractic care excluded, and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by SCAN Balance (HMO C-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar preventive services. Uncovered sub-services include medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, additional smoking cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
SCAN Balance (HMO C-SNP) partially covers hearing services, offering routine hearing exams and fitting evaluations with no deductible. Up to two prescription hearing aids (all types) are covered annually with a copay of $550 to $850 and no coinsurance, while OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by SCAN Balance (HMO C-SNP), providing one routine eye exam and a $250 annual limit for eyewear with no deductible, though eyewear upgrades are not covered. Prior authorization and doctor referrals are required for these services.
Dental Services See details
Dental services are partially covered by SCAN Balance (HMO C-SNP), as orthodontics is not covered. The plan includes preventive care and select advanced services up to a $3,000 annual limit, though specific copay and coinsurance details are not specified.
Home Infusion bundled Services See details
SCAN Balance (HMO C-SNP) covers home infusion bundled services, with Medicare Part B chemotherapy, radiation, and other Part B drugs requiring no copay and 0% to 20% coinsurance. Covered Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Balance (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Medical equipment is partially covered by SCAN Balance (HMO C-SNP), featuring no copay and 0% to 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered under this plan, and prior authorization is required for covered items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under SCAN Balance (HMO C-SNP), requiring prior authorization and doctor referrals. Some diagnostic services are covered with no copay or coinsurance, though diagnostic procedures, tests, and lab services are not covered. Covered diagnostic radiological services carry a $0 to $50 copay and no coinsurance, therapeutic radiological services require a 20% coinsurance and no copay, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the SCAN Balance (HMO C-SNP) plan. Receiving these services requires both prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Balance (HMO C-SNP) plan. While the category is technically listed as covered with prior authorization and a doctor referral, all individual sub-services, including cardiac, pulmonary, and SET for PAD rehabilitation, are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by SCAN Balance (HMO C-SNP), as additional days beyond the Medicare-covered limit are not covered. Covered days require prior authorization and a doctor referral, featuring no copay for days 1 to 20, a $50 daily copay for days 21 to 100, and no coinsurance.
Other Services See details
Other Services are partially covered by SCAN Balance (HMO C-SNP), offering a $35 monthly allowance for over-the-counter items and a covered meal benefit with prior authorization. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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