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SCAN Strive (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Strive (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 (HMO C-SNP) in 2025, please refer to our full plan details page.
SCAN Strive (HMO C-SNP) is a HMO C-SNP plan offered by SCAN Group available for enrollment in 2025 to people living in Bexar and Harris Counties. The overall rating for this plan is not yet available for 2025.
It's important to know that SCAN Strive (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 (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 (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 (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 $590.00 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 $9350.00 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 (HMO C-SNP) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, there is no copay. For standard generic drugs, you pay 24% coinsurance at a preferred pharmacy or preferred mail order, and 25% coinsurance at a standard pharmacy or standard mail order. For preferred brand drugs, you pay 45% coinsurance at any pharmacy.
Additional Benefits
The SCAN Strive (HMO C-SNP) plan offers a variety of healthcare benefits with varying cost-sharing. Many services have a 20% coinsurance, including outpatient, emergency, and vision services. Primary care, home health, and diagnostic services have no copay, while the plan also covers dental, hearing, and home infusion services. The plan includes additional benefits such as transportation services, preventive services, and coverage for medical equipment. This plan provides coverage for inpatient and outpatient services, as well as dental, hearing, and vision care. However, some services like cardiac rehabilitation and certain dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the SCAN Strive (HMO C-SNP) plan. Note that additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital-Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by SCAN Strive (HMO C-SNP). Outpatient Hospital Services, Observation Services, and Outpatient Blood Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a coinsurance of 20%. Outpatient Substance Abuse Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. There is no information about the copay or coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 48 one-way trips per year via rideshare, bus/subway, or medical transport, while 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 Strive (HMO C-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a 20% coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician 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 are covered with 20% coinsurance, but routine care is not covered. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Additional Telehealth Benefits have a coinsurance of 0-20%. Podiatry Services are not covered.
Preventive Services See details
The SCAN Strive (HMO C-SNP) plan covers preventive services, including an annual physical exam, health education, personal emergency response system, In-Home Support Services, support for caregivers, and fitness benefits. Kidney Disease Education Services and other preventive services are covered with 20% coinsurance. The plan does not cover 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, remote access technologies, home and bathroom safety devices, or counseling services.
Hearing Services See details
Hearing Services are partially covered by the SCAN Strive (HMO C-SNP) plan, with hearing exams requiring prior authorization and a doctor referral and a coinsurance of at most 20%. Prescription hearing aids and OTC hearing aids are not covered, and neither are routine hearing exams and fitting/evaluation for hearing aids.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams have a 20% coinsurance, and eyewear, including contact lenses, has a 20% coinsurance with a combined maximum benefit of $350 per year; upgrades are not covered.
Dental Services See details
Dental Services are covered by the SCAN Strive (HMO C-SNP) plan, with 20% coinsurance for Medicare Dental Services. Other services include coverage for Oral Exams (limited to 2 visits per year), Dental X-Rays (limited to 1 per year), Other Diagnostic Dental Services, Prophylaxis (Cleaning) (limited to 2 visits per year), Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery. Fluoride Treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered. Orthodontic Services have a maximum plan benefit coverage of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the SCAN Strive (HMO C-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SCAN Strive (HMO C-SNP) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the SCAN Strive (HMO C-SNP) plan, with Durable Medical Equipment (DME) subject to 0-20% coinsurance and Prosthetic Devices, and Medical Supplies subject to 20% coinsurance. 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 under the SCAN Strive (HMO C-SNP) plan, with no copay. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the SCAN Strive (HMO C-SNP) plan with no copay and no coinsurance, but require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the SCAN Strive (HMO C-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN Strive (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and non-Medicare-covered stays for SNF are not covered. The copay information is available in the plan documents.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits; however, Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered. Over-the-Counter Items have a maximum plan benefit coverage amount of $75.00 every month, and Meal Benefits require prior authorization.
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