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SCAN MyChoice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN MyChoice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN MyChoice (HMO) in 2026, please refer to our full plan details page.
SCAN MyChoice (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 MyChoice (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 MyChoice (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 MyChoice (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 $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 SCAN MyChoice (HMO) Medicare Advantage plan features an Enhanced Alternative drug benefit with a $250.00 annual prescription drug deductible. After meeting this deductible during the initial coverage phase, you will have no copay for Tier 1 preferred generic drugs at preferred or standard pharmacies and mail-order services. For Tier 2 standard generic drugs, the plan requires a copay of $42.00 at preferred locations or $43.00 at standard locations. For higher-tier medications, Tier 3 preferred brand drugs carry a 35% coinsurance, and Tier 4 non-preferred drugs carry a 30% coinsurance. Once your yearly out-of-pocket drug expenses reach $2,100.00, you will enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, members who qualify for the low-income subsidy can reduce their Part D premium to zero.
Additional Benefits
The SCAN MyChoice (HMO) plan offers robust coverage for essential medical needs, including inpatient hospital stays with a $100 daily copay for the first five days and no copay for days six through 90. Outpatient services and emergency care are covered with moderate copays, while primary care visits and routine preventive services require a low $5 copay or no copay at all. Emergency room visits carry a $90 copay, which is waived upon hospital admission, and urgent care services require no copay. For additional wellness needs, the plan provides routine vision and hearing exams with no copay, a $230 quarterly eyewear allowance, and covered dental services. Skilled nursing facility stays feature no copay for the first 20 days, and acupuncture, meals, and over-the-counter items are also available with little to no out-of-pocket costs. While certain specialized services like dialysis and medical equipment require up to 20% coinsurance, many covered benefits feature no deductible and no coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by SCAN MyChoice (HMO) with a $100 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance. While inpatient acute and psychiatric stays are covered, non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN MyChoice (HMO) covers outpatient services, including outpatient hospital and ambulatory surgical center services with a $100 copay and no coinsurance. Outpatient substance abuse services require a $5 copay with no coinsurance, and outpatient blood services are covered with no deductible, no copay, and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by SCAN MyChoice (HMO) with a $55 copay and no coinsurance. This service requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
SCAN MyChoice (HMO) partially covers Ambulance and Transportation Services, offering ground and air ambulance services for a $150 copay and no coinsurance. Prior authorization is required for ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
SCAN MyChoice (HMO) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital, and urgently needed services with no copay or coinsurance. Worldwide emergency services are also covered with no coinsurance, requiring a $90 copay for emergency care and a $150 copay for emergency transportation.
Primary Care See details
Primary care benefits are partially covered by SCAN MyChoice (HMO), as podiatry services are not covered. Most covered services, including occupational therapy, physical therapy, routine chiropractic care, psychiatric services, and opioid treatment, require a $5 copay and carry no coinsurance.
Preventive Services See details
Preventive services are covered under the SCAN MyChoice (HMO) plan with no copay and no coinsurance for Medicare-covered zero-dollar preventive services and annual physical exams. Additional preventive benefits are only partially covered, with exclusions for in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, home safety devices, counseling, and additional smoking cessation sessions.
Hearing Services See details
Hearing services are partially covered under SCAN MyChoice (HMO), featuring diagnostic and routine exams with no deductible, copay, or coinsurance, alongside coverage for up to two prescription hearing aids per year with no coinsurance and a copay of $550 to $850. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
SCAN MyChoice (HMO) partially covers vision services with no deductibles, offering one routine eye exam annually and a $230 eyewear allowance every three months, though eyewear upgrades are not covered. Doctor referrals and prior authorizations are required for these services.
Dental Services See details
SCAN MyChoice (HMO) partially covers dental services, including exams, cleanings, and various restorative procedures, though orthodontics is not covered. While copay and coinsurance details are not specified, orthodontic services have a maximum plan benefit of $230 every three months, and prior authorization is required for Medicare dental services.
Home Infusion bundled Services See details
SCAN MyChoice (HMO) covers home infusion bundled services with prior authorization, offering chemotherapy, radiation, and other Part B drugs with no copay and coinsurance ranging from no coinsurance up to 20%. Medicare Part B insulin drugs under this benefit require a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
SCAN MyChoice (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these services.
Medical Equipment See details
SCAN MyChoice (HMO) partially covers medical equipment, as diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Covered services, such as durable medical equipment, prosthetics, and medical supplies, require prior authorization and feature no copay and no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under SCAN MyChoice (HMO), with prior authorization and a doctor referral required. Some diagnostic services are covered with no copay or coinsurance, but diagnostic procedures, tests, lab services, and outpatient X-ray services are not covered. Covered diagnostic radiological services require a copay of $0 to $50 with no coinsurance, while therapeutic radiological services require a 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered by SCAN MyChoice (HMO), requiring both prior authorization and a doctor referral. Specific copay and coinsurance costs are not provided in the plan details, so members should verify potential out-of-pocket costs directly with the provider.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN MyChoice (HMO) plan, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice (HMO) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance for days 1 through 20, and a $50 daily copay and no coinsurance for days 21 through 100. While prior authorization and a doctor referral are required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SCAN MyChoice (HMO) partially covers Other Services, featuring acupuncture with a $5 copay and no coinsurance for up to 12 treatments per year, as well as over-the-counter items and meal benefits with no copay or coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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