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SCAN Desert Choice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Desert Choice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Desert Choice (HMO) in 2026, please refer to our full plan details page.
SCAN Desert Choice (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2026 to people living in Riverside County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that SCAN Desert Choice (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 Desert Choice (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 Desert Choice (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 $2499.00 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 Desert Choice (HMO) Medicare plan features an Enhanced Alternative drug benefit with a $250 annual prescription drug deductible. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $12 copay. For Tier 2 standard generic drugs, copays are $42 at preferred locations and $47 at standard locations. Tier 3 preferred brand drugs require a 35% coinsurance, and Tier 4 non-preferred drugs require a 30% coinsurance across all pharmacy types. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and will pay nothing for covered Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy may see their Part D premium reduced to $0.
Additional Benefits
The SCAN Desert Choice (HMO) plan offers robust healthcare coverage with predictable out-of-pocket costs, featuring a $100 daily copay for inpatient hospital stays during days one through three and no copay for days four through ninety. Emergency services require a $120 copay, which is waived upon admission, while urgent care services are available with no copay. Additionally, the plan features no copay for preventive services and routine eye exams, helping you manage your primary health needs affordably. For specialized care, the plan provides comprehensive dental coverage of up to $4,000 annually for preventive and advanced procedures, alongside a $175 annual allowance for eyewear with no copay. Members also benefit from a $100 quarterly over-the-counter allowance, up to 22 one-way health-related transportation trips per year, and prescription hearing aid coverage with copays ranging from $550 to $850. While many services like dialysis require a low $25 copay, please note that cardiac rehabilitation is not covered under this plan.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by SCAN Desert Choice (HMO), requiring a $100 daily copay for days 1 through 3, no copay for days 4 through 90, and no coinsurance. Non-Medicare-covered stays, upgrades, and additional days for psychiatric stays are not covered.
Outpatient Services See details
SCAN Desert Choice (HMO) covers outpatient services, including hospital, observation, and ambulatory surgical center services, with prior authorization and referrals required. Outpatient substance abuse sessions are covered with a $10 copay and no coinsurance, and outpatient blood services are covered with no deductible.
Partial Hospitalization See details
SCAN Desert Choice (HMO) covers partial hospitalization services with a $10.00 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 covered under SCAN Desert Choice (HMO), with transportation being partially covered as trips to any health-related location are not covered. Covered ground and air ambulance services require a $200 copay and no coinsurance, while plan-approved health-related transportation is covered for up to 22 one-way trips per year.
Emergency Services See details
SCAN Desert Choice (HMO) covers emergency services with a $120 copay and no coinsurance, with the copay waived upon hospital admission. Urgently needed services require no copay or coinsurance, while worldwide emergency services are covered with a $120 copay and a $200 copay for emergency transportation.
Primary Care See details
Primary Care benefits are partially covered by SCAN Desert Choice (HMO), as podiatry services and individual or group sessions for psychiatric and mental health specialty services are not covered. Other covered services, such as physical therapy, chiropractic care, and telehealth, require prior authorization and doctor referrals, with opioid treatment services requiring a $10 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by SCAN Desert Choice (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services. While annual exams and fitness benefits are included, the plan does not cover in-home safety assessments, 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 smoking cessation sessions, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
SCAN Desert Choice (HMO) covers annual routine hearing exams and unlimited fitting evaluations with no deductible, and prescription hearing aids are covered with a copay of $550 to $850 and no coinsurance. This benefit is partially covered, as OTC hearing aids and specific prescription types (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Vision Services are partially covered by SCAN Desert Choice (HMO), which offers one routine eye exam and eyewear per year with no deductibles, copays, or coinsurance, up to a $175 annual limit. Eyewear upgrades are not covered under this plan, and prior authorization along with a doctor referral are required for services.
Dental Services See details
Dental services are partially covered by SCAN Desert Choice (HMO), which excludes coverage for orthodontics but provides up to $4,000 annually for comprehensive services like implants, prosthodontics, and oral surgery. Preventive care such as exams, cleanings, and x-rays is covered, though prior authorization is required for Medicare dental and most comprehensive procedures.
Home Infusion bundled Services See details
SCAN Desert Choice (HMO) covers Home Infusion bundled Services with prior authorization and step therapy. Chemotherapy, radiation, and other Part B drugs carry no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Desert Choice (HMO) with a $25 copay and no coinsurance. Prior authorization and a doctor referral are required to receive this benefit.
Medical Equipment See details
SCAN Desert Choice (HMO) covers Durable Medical Equipment (DME) with prior authorization required, though specific copay and coinsurance details are not specified. For prosthetics, medical supplies, and diabetic equipment, some services are covered, but prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered in practice.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by SCAN Desert Choice (HMO), requiring a doctor referral and prior authorization. Some diagnostic services are covered with no copay or coinsurance, but diagnostic procedures, tests, and lab services are not covered. Therapeutic radiological services are covered with a $50 copay and no coinsurance, while diagnostic radiological and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by SCAN Desert Choice (HMO), requiring both prior authorization and a doctor referral. Specific copay and coinsurance costs are not detailed in this plan summary.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Desert Choice (HMO) plan, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice. Because there is no coverage for these services, there are no associated copays or coinsurance.
Skilled Nursing Facility (SNF) See details
SCAN Desert Choice (HMO) partially covers Skilled Nursing Facility (SNF) services, though additional days beyond the standard Medicare-covered limit are not covered. This benefit requires prior authorization and a doctor referral but requires no prior hospital stay, with specific copay and coinsurance cost-sharing details not specified.
Other Services See details
Other Services are partially covered by SCAN Desert Choice (HMO), which includes acupuncture up to 20 treatments annually, a $100 quarterly over-the-counter benefit, and limited meal delivery after hospital stays. Prior authorization is required for acupuncture and meals, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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