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SCAN Essential Savings (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Essential Savings (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Essential Savings (HMO) in 2026, please refer to our full plan details page.
SCAN Essential Savings (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2026 to people living in Los Angeles County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that SCAN Essential Savings (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 Essential Savings (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 Essential Savings (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. Additionally, this plan comes with a Part B Premium reduction of $185.00. You must continue to pay paying your reduced 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 $2400.00 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 Essential Savings (HMO) Medicare plan features a $250 annual prescription drug deductible and provides enhanced alternative drug coverage. During the initial coverage phase, you will benefit from no copay for Tier 1 preferred generic drugs at both preferred and standard pharmacies. For Tier 2 standard generic drugs, you will pay a copay of $42 or $43, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 35% and 30% coinsurance, respectively. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, if you qualify for the Low-Income Subsidy, your Part D premium can be reduced to zero. This plan offers a structured and cost-effective pathway to managing your prescription medication expenses.
Additional Benefits
The SCAN Essential Savings (HMO) plan offers affordable coverage with low out-of-pocket costs for your essential medical needs. You will enjoy no copay for preventive services, annual physicals, urgently needed care, and the first 20 days of a skilled nursing facility stay. Primary care visits range from no copay up to $40, while inpatient hospital stays require a $50 daily copay for the first five days. Emergency room visits carry a $90 copay, which is waived if you are admitted, and ambulance services require a $125 copay. While select dental services and routine vision exams are available with no copay, please note that this plan does not cover eyewear, hearing aids, or cardiac rehabilitation. Additionally, home infusion services and durable medical equipment are covered with coinsurance ranging from zero to 20 percent and no copay.
Inpatient Hospital See details
SCAN Essential Savings (HMO) covers inpatient acute hospital stays with a $50 daily copay for days 1-5 and inpatient psychiatric stays with a $125 daily copay for days 1-5, with no copay for days 6-90 and no coinsurance for either service. This benefit is partially covered as non-Medicare-covered stays, upgrades for acute stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
SCAN Essential Savings (HMO) covers outpatient services with outpatient hospital copays ranging from $15 to $225 and outpatient substance abuse therapy copays at $40, with no coinsurance required. Prior authorization and doctor referrals are required for most of these covered services, which also include ambulatory surgical center, observation, and blood services.
Partial Hospitalization See details
SCAN Essential Savings (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by SCAN Essential Savings (HMO), which features a $125 copay and no coinsurance for ground and air ambulance services, subject to prior authorization. However, transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
SCAN Essential Savings (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 have no copay and no coinsurance, while worldwide emergency services are covered with a $90 copay for emergency care, a $125 copay for emergency transportation, and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by SCAN Essential Savings (HMO) with no coinsurance and copayments ranging from no copay up to $40, though podiatry services and routine chiropractic care are not covered. Covered services include primary care physician visits, specialist services, physical and occupational therapies, mental health sessions, and telehealth.
Preventive Services See details
Preventive Services are covered by SCAN Essential Savings (HMO), offering no copay and no coinsurance for Medicare-covered zero-dollar preventive services, annual physical exams, and kidney disease education. However, this benefit is only partially covered, as it excludes in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, additional tobacco cessation counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling services.
Hearing Services See details
SCAN Essential Savings (HMO) hearing services cover some services with a $15 copay and no coinsurance, but routine hearing exams, fitting and evaluation, prescription hearing aids, and over-the-counter hearing aids are not covered. Prior authorization and a doctor referral are required for the covered exams.
Vision Services See details
Vision services are covered by the SCAN Essential Savings (HMO) plan, offering annual routine eye exams with no deductible, no coinsurance, and no copay to a $5 copay. For eyewear, some services are covered, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by SCAN Essential Savings (HMO), which covers Medicare dental services with a $15 copay and no coinsurance, and select preventive and periodontic services with no copay and no coinsurance. Restorative services, adjunctive general services, endodontics, prosthodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Essential Savings (HMO) covers home infusion bundled services with prior authorization, requiring 0% to 20% coinsurance and no copay for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Essential Savings (HMO) with a $25 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
SCAN Essential Savings (HMO) partially covers medical equipment with no copays, though diabetic supplies are not covered. Covered durable medical equipment, prosthetics, and medical supplies require prior authorization and carry a coinsurance ranging from no coinsurance to 20%, while diabetic therapeutic shoes require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Essential Savings (HMO) because lab services and outpatient X-ray services are not covered. Covered diagnostic procedures require a $5 copay, diagnostic radiological services range from no copay to a $75 copay, and therapeutic radiological services carry a $60 copay, all with no coinsurance.
Home Health Services See details
Home health services are covered under the SCAN Essential Savings (HMO) plan, requiring prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Essential Savings (HMO) plan, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
SCAN Essential Savings (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $100 daily copay for days 21 to 100. Prior authorization and a doctor referral are required, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
SCAN Essential Savings (HMO) does not cover Other Services, as acupuncture, over-the-counter (OTC) items, meal benefits, and highly integrated dual eligible SNP services are all excluded from coverage.
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