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SCAN Strive Texas (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Strive 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 Strive Texas (HMO C-SNP) in 2026, please refer to our full plan details page.
SCAN Strive 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 Strive 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 Strive 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 Strive 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 Strive 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 a $615.00 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 $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 Strive Texas (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. For both Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for one-, two-, or three-month fills at all preferred, standard, and mail-order pharmacies. This structure provides excellent cost savings for those relying primarily on generic prescriptions. For higher-tier medications, costs are determined by coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance at preferred pharmacies and mail order, or 25% at standard pharmacies, while Tier 4 non-preferred drugs have a 30% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply regardless of the pharmacy network you choose.
Additional Benefits
The SCAN Strive Texas (HMO C-SNP) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay and no coinsurance for primary care, specialist visits, and home health services. For inpatient hospital care, members pay a $95 copay per day for days 1 through 5 of an acute stay and no coinsurance, while emergency room visits carry a $90 copay. Outpatient hospital services require a $15 to $175 copay, and ambulatory surgical center services are available for a $15 copay with no coinsurance. This plan also includes valuable everyday benefits, such as up to 48 one-way transportation trips and covered preventive dental services with no copay and no coinsurance. Vision care is supported with diagnostic exams and up to $350 annually for eyewear with no copay, while routine eye exams range from no copay to a $15 copay. Additionally, members can access a monthly over-the-counter allowance of up to $105 and post-hospitalization meals with no copay or coinsurance.
Inpatient Hospital See details
SCAN Strive Texas (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $95 copay for days 1 through 5 of an acute stay and a $125 copay for days 1 through 5 of a psychiatric stay, with no copay for days 6 through 90. Additional acute stay days are unlimited, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
SCAN Strive Texas (HMO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center services for a $15 copay and outpatient blood services with no copay and no deductible. Outpatient hospital services require a $15 to $175 copay with no coinsurance, and while some outpatient substance abuse services are covered with no copay and no coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by SCAN Strive Texas (HMO C-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for these services, and some options may also require a referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by SCAN Strive Texas (HMO C-SNP), featuring a $225 copay and no coinsurance for both ground and air ambulance services. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
SCAN Strive Texas (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency and urgent care are also covered with no coinsurance, featuring a $90 copay for emergency services, a $25 copay for urgent care, and a $225 copay for emergency transportation.
Primary Care See details
SCAN Strive Texas (HMO C-SNP) covers primary care, specialist visits, and opioid treatment with no copay and no coinsurance, while telehealth services have a copay of $0 to $25 and no coinsurance. Physical, occupational, and speech therapies, along with psychiatric and mental health services, require a $15 copay and no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
SCAN Strive Texas (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance, though certain benefits require prior authorization or referrals. Uncovered sub-services include 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 counseling, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by SCAN Strive Texas (HMO C-SNP), which offers diagnostic hearing exams with no copay, no coinsurance, and no deductible. However, routine hearing exams, hearing aid fittings and evaluations, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered under this plan.
Vision Services See details
Vision Services are partially covered by SCAN Strive Texas (HMO C-SNP) with no deductibles or coinsurance, featuring routine eye exams for a $0 to $15 copay and up to $350 annually for eyewear with no copay. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by SCAN Strive Texas (HMO C-SNP), with other diagnostic dental services, other preventive dental services, and orthodontics not covered. Medicare-covered dental services require a $15 copay and no coinsurance, while all other covered preventive and comprehensive services are offered with no copay and no coinsurance.
Home Infusion bundled Services See details
SCAN Strive Texas (HMO C-SNP) covers Home Infusion bundled Services with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, insulin, and other drugs require no coinsurance to 20% coinsurance, with insulin drugs specifically featuring a $35 copay.
Dialysis Services See details
SCAN Strive 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 Strive Texas (HMO C-SNP) with no copay, though prior authorization is required. Durable medical equipment ranges from no coinsurance to 20% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes require 20% coinsurance; however, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
SCAN Strive Texas (HMO C-SNP) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization and referrals for these benefits. Covered diagnostic procedures and therapeutic radiological services have a $30 copay, diagnostic radiological services have no copay, while lab services and outpatient X-ray services are not covered.
Home Health Services See details
SCAN Strive Texas (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
SCAN Strive Texas (HMO C-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN Strive Texas (HMO C-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $150 copay for days 21 to 100. Prior authorization and a referral are required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SCAN Strive Texas (HMO C-SNP) provides partially covered other services, featuring over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit offers up to $105 monthly, and the meal benefit requires prior authorization for post-hospitalization or chronic illness recovery.
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