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SCAN Balance Texas (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Balance Texas (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 Texas (HMO C-SNP) in 2026, please refer to our full plan details page.
SCAN Balance Texas (HMO C-SNP) is a HMO C-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in Bexar, Harris, Fort Bend and Montgomery Counties. The overall rating for this plan is not yet available for 2026.
It's important to know that SCAN Balance Texas (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 Texas (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 Texas (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 Texas (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 no drug deductible. Your prescription medication coverage will start immediately.
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 Texas (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. You will pay no copay for Tier 1 preferred generic drugs across all preferred, standard, and mail-order pharmacies. Tier 2 generic drugs also feature no copay when filled through preferred pharmacies or preferred mail-order services, though standard pharmacies charge a $7 copay for a one-month supply. For Tier 3 preferred brand drugs, copays start at $42 for a one-month supply at preferred pharmacies and $47 at standard pharmacies. Tier 4 non-preferred drugs require a 35% coinsurance, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
The SCAN Balance Texas (HMO C-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, preventive care, and home health services. For inpatient hospital stays, members pay a daily copay of $95 for days 1 to 5 of acute stays, while outpatient hospital services require a $15 to $150 copay, both with no coinsurance. Emergency care carries a $90 copay that is waived if admitted, and skilled nursing facility stays feature no copay for the first 20 days. This plan also includes valuable everyday health benefits, featuring dental care with no copay up to a $3,500 annual limit and routine vision care with no copay for eyewear up to a $325 annual limit. Routine hearing exams also require no copay, though prescription hearing aids have copays ranging from $550 to $850. Additionally, members benefit from a monthly $55 over-the-counter allowance and up to 54 one-way transportation trips per year with no copay.
Inpatient Hospital See details
SCAN Balance Texas (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $95 daily copay for days 1 to 5 of acute stays and a $125 daily copay for days 1 to 5 of psychiatric stays, followed by no copay for days 6 to 90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by SCAN Balance Texas (HMO C-SNP) with no coinsurance, featuring a $15 to $150 copay for outpatient hospital services and a $15 copay for ambulatory surgical center and substance abuse sessions. Outpatient blood services are covered with no copay or deductible, although prior authorization and referrals are required.
Partial Hospitalization See details
SCAN Balance Texas (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit, and a referral may also be necessary.
Ambulance and Transportation Services See details
SCAN Balance Texas (HMO C-SNP) covers ground and air ambulance services with a $225 copay and no coinsurance per trip, which require prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 54 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
SCAN Balance Texas (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays ranging from $20 to $225 and no coinsurance.
Primary Care See details
Primary care benefits under the SCAN Balance Texas (HMO C-SNP) plan feature primary care provider visits with no copay and no coinsurance, while other services like specialist visits, mental health, and physical therapy have copays ranging from $0 to $20 and no coinsurance. Podiatry services are not covered, and chiropractic care is only partially covered, with other chiropractic services excluded.
Preventive Services See details
SCAN Balance Texas (HMO C-SNP) covers preventive services with no copay and no coinsurance, although some services require prior authorization or a referral. This benefit is partially covered, including services like health education, in-home safety assessments, and caregiver support, while excluding sub-services such as medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by SCAN Balance Texas (HMO C-SNP), offering routine and diagnostic exams with no copay and no coinsurance when obtaining a referral and prior authorization. Prescription hearing aids are covered up to two per year with no coinsurance and a copay ranging from $550 to $850, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are covered by SCAN Balance Texas (HMO C-SNP), offering routine eye exams with a $0 to $15 copay and no coinsurance, alongside eyewear covered with no copay, no coinsurance, and a $325 annual limit. This benefit is partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by SCAN Balance Texas (HMO C-SNP) with no copay and no coinsurance for covered services, up to a $3,500 annual maximum. Other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SCAN Balance Texas (HMO C-SNP) with no copay, although prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance up to 20%, while Medicare Part B insulin drugs require a $35 copay and no coinsurance up to 20% coinsurance.
Dialysis Services See details
SCAN Balance Texas (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is partially covered by SCAN Balance Texas (HMO C-SNP), as diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Covered durable medical equipment and prosthetics require no copay and 0% to 20% coinsurance, while covered diabetic equipment features no copay and no coinsurance, with prior authorization required.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under SCAN Balance Texas (HMO C-SNP) with no coinsurance, though referrals and prior authorizations are required. Diagnostic procedures and therapeutic radiological services require a $30 copay, diagnostic radiological services have no copay, and lab services and outpatient X-ray services are not covered.
Home Health Services See details
SCAN Balance Texas (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SCAN Balance Texas (HMO C-SNP) plan, as all associated sub-services, including intensive cardiac, pulmonary, and SET for PAD services, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
SCAN Balance Texas (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $140 daily copay for days 21 through 100. Prior authorization and referrals are required for these services, which do not require a prior three-day inpatient hospital stay.
Other Services See details
SCAN Balance Texas (HMO C-SNP) covers other services including acupuncture for a $5 copay and no coinsurance (limited to 20 treatments per year), a monthly $55 over-the-counter allowance with no copay or coinsurance, and limited-duration meal benefits with no copay or coinsurance. Prior authorization is required for acupuncture and meal benefits.
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