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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 2025, please refer to our full plan details page.
SCAN Classic (HMO) is a HMO plan offered by SCAN Group available for enrollment in 2025 to people living in Bexar County. The overall rating for this plan is not yet available for 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2900.00 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 Classic (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at a preferred pharmacy or through mail order, while standard generic drugs have a $42 or $47 copay, depending on the pharmacy. Preferred brand drugs and non-preferred drugs have a 50% and 33% coinsurance, respectively. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The SCAN Classic (HMO) plan offers a wide range of benefits with varying cost-sharing. You'll have copays for services like inpatient hospital stays, outpatient services, primary care visits, and hearing and vision exams. Some services, such as home health and preventive services, are covered with no copay. The plan also covers specific services like ambulance, emergency care, dental, and hearing services with copays. Additionally, you'll find coverage for medical equipment, home infusion, and dialysis services with coinsurance. The plan includes other benefits such as acupuncture and an over-the-counter item allowance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute, you'll pay a $95 copay for days 1-5, and no copay for days 6-90; additional days are unlimited with no copay. For Inpatient Hospital Psychiatric, you'll pay a $125 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $15 and $175, observation services, ambulatory surgical center services with a $15 copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services. Prior authorization and a doctor referral are required for all of these services.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $225 copay, and transportation services to a plan-approved health-related location with 54 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the SCAN Classic (HMO) plan. Emergency Services has a $90 copay, Urgently Needed Services has a $25 copay, and Worldwide Emergency Services has a copay depending on the service: $90 for Worldwide Emergency Coverage, $25 for Worldwide Urgent Coverage, and $225 for Worldwide Emergency Transportation.
Primary Care See details
The SCAN Classic (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, physician specialist services with a $15 copay, mental health specialty services with a $15 copay, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0-$25, and opioid treatment program services with a $15 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, health education, personal emergency response systems, in-home support services, support for caregivers of enrollees, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, are covered. In-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $15 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $550 and $850, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The SCAN Classic (HMO) plan covers vision services, including routine eye exams with a $15 copay, and eyewear with a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, with a limit of one pair or set per year. Upgrades are not covered.
Dental Services See details
The SCAN Classic (HMO) plan covers Medicare Dental Services with a $15 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and oral and maxillofacial surgery. Fluoride treatment, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, and orthodontics are not covered. Orthodontic Services are covered up to a maximum of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the SCAN Classic (HMO) plan. You will pay 20% coinsurance for this benefit, and prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, Prosthetic Devices with 0% to 20% coinsurance and no copay, and Medical Supplies with 0% to 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a $30 copay, while Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $125, and Therapeutic Radiological Services have a copay of at most $30; Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Classic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by SCAN Classic (HMO), but the plan does not cover the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN Classic (HMO) with prior authorization and a doctor referral required. For days 1-20, there is no copay, and for days 21-100, the copay is $150. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $5 copay, Over-the-Counter (OTC) Items with a maximum plan benefit coverage amount of $85 every three months, and a meal benefit. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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