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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 Harris 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 varying copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, and a $7 copay at standard pharmacies and standard mail order. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The SCAN Classic (HMO) plan offers coverage for a variety of healthcare services. This plan includes coverage for inpatient hospital stays with a copay, outpatient services with copays ranging from $15 to $150, and emergency services with a $90 copay. You'll also find coverage for primary care, hearing and vision services, and dental services, along with coverage for home health services, skilled nursing facilities, and home infusion services. Additional benefits of this plan include ambulance and transportation services, preventive services, and medical equipment. The plan also covers diagnostic and radiological services with a copay, and dialysis services with 20% coinsurance. Other services like acupuncture and over-the-counter items are covered, and there are no copays for home health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-2, and no copay for days 3-90, while Inpatient Hospital Psychiatric services have a $200 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay of $15 to $150, and Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a copay of $15.
Partial Hospitalization See details
SCAN Classic (HMO) covers partial hospitalization with a $55 copay, but prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $225 copay. Transportation Services to a plan-approved health-related location are covered for up to 54 one-way trips per year, using rideshare services, bus/subway, or medical transport. 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 and Worldwide Emergency Coverage have a $90 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $20 copay, and Worldwide Emergency Transportation has a $225 copay. There is no coinsurance for any of these services.
Primary Care See details
SCAN Classic (HMO) covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $15 copay, and Routine Chiropractic Care has a $5 copay for up to 20 visits per year. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a $15 copay, and Additional Telehealth Benefits have a $0-$20 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $15 copay for individual and group sessions.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans, such as Health Education, Personal Emergency Response System (PERS), In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefit. Other services like In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), 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 for all types, but hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
SCAN Classic (HMO) covers vision services, including routine eye exams with a $15 copay. Eyewear is covered with a combined maximum benefit of $250 every two years, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered with limitations on the number of pairs or frames allowed. Upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams and cleaning, with 2 oral exams and 2 cleanings covered per year. Other diagnostic dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery are covered, but fluoride treatment, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services have a maximum plan benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Classic (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the SCAN Classic (HMO) plan. This benefit has a coinsurance of 20%, and requires prior authorization and a doctor's referral.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment with coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, but Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
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 $150, and Therapeutic Radiological Services have a $60 copay. 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 prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the SCAN Classic (HMO) plan, but there is no information about cost sharing. However, specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Classic (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $140. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Under the SCAN Classic (HMO) plan, acupuncture is covered with a $5 copay, while over-the-counter items are covered up to $65 every three months. Meal benefits are also covered. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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