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SCAN MyChoice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN MyChoice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN MyChoice (HMO) in 2025, please refer to our full plan details page.
SCAN MyChoice (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 MyChoice (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 MyChoice (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 MyChoice (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 MyChoice (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred generic drugs, while standard generic drugs have a $42-$43 copay depending on the pharmacy. For preferred brand drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The SCAN MyChoice (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency, primary care, preventive, hearing, vision, and dental services are covered, with copays ranging from $0 to $175. The plan also provides additional benefits such as medical equipment, home health services, and skilled nursing facilities, with some services requiring prior authorization and referrals. This plan includes coverage for ambulance services, along with diagnostic, radiological, and dialysis services. The plan also includes coverage for home infusion and other services, like acupuncture and over-the-counter items. However, note that certain services like cardiac rehabilitation and specific dental and vision upgrades may not be covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $95 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $125 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $15-$175, observation services, ambulatory surgical center services with a $15 copay, outpatient substance abuse services, and outpatient blood services. Individual and group sessions for outpatient substance abuse have a copay of $20.
Partial Hospitalization See details
Partial Hospitalization is covered under the SCAN MyChoice (HMO) plan, but requires prior authorization and a doctor referral. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by SCAN MyChoice (HMO). Ground and Air Ambulance Services have a $225 copay, and there is no coinsurance. 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 under the SCAN MyChoice (HMO) plan. Emergency Services has a $90 copay, Urgently Needed Services has a $25 copay, and Worldwide Emergency Coverage has a $90 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $225 copay.
Primary Care See details
SCAN MyChoice (HMO) 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, and mental health specialty services with a $15 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $15 copay. Podiatry services are not covered.
Preventive Services See details
The SCAN MyChoice (HMO) plan covers preventive services, including Medicare-covered services with no copay, as well as annual physical exams and additional preventive services. Additional benefits include Health Education, Personal Emergency Response System, Fitness Benefit, In-Home Support Services, Support for Caregivers of Enrollees, Remote Access Technologies, and Kidney Disease Education Services. Some services, like In-Home Safety Assessment, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $15 copay, and fitting/evaluation for hearing aids with no copay; however, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered. Prescription hearing aids (all types) have a copay between $550 and $850, with a limit of 2 per year.
Vision Services See details
Vision services include eye exams with a $15 copay, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, all of which are covered. Eyewear has a maximum plan benefit coverage of $300 per year. Upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers Medicare Dental Services with a $15 copay, as well as other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery. Fluoride treatments, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered. Orthodontic services have a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%. 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 MyChoice (HMO) plan, but require prior authorization and a doctor's referral. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered by SCAN MyChoice (HMO), including Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetic Devices with 0-20% coinsurance. 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 include coverage for Diagnostic Procedures/Tests with a copay of $30, Diagnostic Radiological Services with a copay up to $125, and Therapeutic Radiological Services with a copay of $30. Lab Services and Outpatient X-Ray Services are not covered by this plan.
Home Health Services See details
Home Health Services are covered by the SCAN MyChoice (HMO) plan with no copay and no coinsurance, but 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 not covered by the SCAN MyChoice (HMO) plan. Prior authorization and a doctor's referral are required for the services, but the plan does not cover any of the listed services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SCAN MyChoice (HMO) with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $150.
Other Services See details
Other Services include acupuncture with a $5 copay, and up to 12 treatments per year, as well as over-the-counter (OTC) items with a maximum benefit coverage amount of $75 every three months, and a meal benefit for those who have recently had surgery or a hospital stay, or have a chronic illness or medical condition. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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