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SCAN Classic Texas (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN Classic Texas (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN Classic Texas (HMO) in 2026, please refer to our full plan details page.
SCAN Classic Texas (HMO) is a HMO 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 Classic Texas (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 Texas (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 Texas (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 Texas (HMO) Medicare prescription drug plan features a $0 drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for any supply length at all pharmacies and mail-order services. Tier 2 generic drugs also feature no copay when filled through preferred pharmacies or preferred mail order, while standard pharmacies and mail order require a $7 copay for a 1-month supply. For Tier 3 preferred brand drugs, copays start at $42 for a 1-month supply at preferred locations and mail order, compared to $47 at standard locations. Tier 4 non-preferred drugs require a 35% coinsurance regardless of where you fill your prescription. Tier 5 specialty drugs are subject to a 33% coinsurance for a 1-month supply across all pharmacy and mail-order options.
Additional Benefits
The SCAN Classic Texas (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. For specialist visits, routine hearing exams, and outpatient services, members will pay low copays starting at just $15 with no coinsurance. Inpatient hospital stays require a $95 daily copay for the first five days, while skilled nursing facility stays have no copay for the first 20 days. This plan also includes valuable extra benefits, such as dental coverage up to $3,500 annually with no copay, and a $300 annual eyewear allowance. Additionally, members can take advantage of 54 free one-way transportation trips per year and a $100 quarterly over-the-counter allowance. While most services feature no coinsurance, certain items like durable medical equipment and Part B drugs may require up to 20% coinsurance.
Inpatient Hospital See details
SCAN Classic Texas (HMO) covers inpatient hospital services with no coinsurance, featuring a $95 daily copay for days 1 to 5 of acute stays (no copay for days 6 to 90 with unlimited additional days) and a $125 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SCAN Classic Texas (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $15 to $150 for outpatient hospital care and a flat $15 copay for ambulatory surgical center and substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, though prior authorization and referrals are generally required.
Partial Hospitalization See details
SCAN Classic Texas (HMO) covers partial hospitalization with a $55 copay and no coinsurance. Prior authorization and referrals are required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by SCAN Classic Texas (HMO), with ground and air ambulance services requiring a $225 copay and no coinsurance. The plan also offers up to 54 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services under the SCAN Classic Texas (HMO) are covered with a $90 copay—which is waived if you are immediately admitted to the hospital—and no coinsurance, while urgently needed services require a $20 copay and no coinsurance. Worldwide emergency care, urgent care, and emergency transportation are also covered with copays of $90, $20, and $225 respectively, with no coinsurance.
Primary Care See details
SCAN Classic Texas (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $15 copay and no coinsurance. Chiropractic benefits are partially covered with a $5 copay for routine care (other chiropractic services are not covered), telehealth ranges from a $0 to $20 copay, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by SCAN Classic Texas (HMO) with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive services are partially covered; however, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, smoking cessation, disease management, telemonitoring, home safety modifications, and counseling are not covered.
Hearing Services See details
SCAN Classic Texas (HMO) covers routine hearing exams with a $15 copay and no coinsurance, as well as unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $550 to $850 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
SCAN Classic Texas (HMO) partially covers vision services, offering routine eye exams with a $0 to $15 copay and eyewear with no copay, both with no coinsurance. Other eye exam services and eyewear upgrades are not covered, and covered eyewear is subject to a $300 annual maximum allowance.
Dental Services See details
Dental services are partially covered by SCAN Classic Texas (HMO) with no copay and no coinsurance for covered benefits, up to a plan-specified maximum of $3,500 per year. Although many preventive and comprehensive services are covered, other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
SCAN Classic Texas (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs require between no coinsurance and 20% coinsurance, while Part B insulin drugs have a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SCAN Classic Texas (HMO) with no copay and a 20% coinsurance, requiring both prior authorization and a referral.
Medical Equipment See details
SCAN Classic Texas (HMO) covers medical equipment with no copay, though coinsurance ranges from 0% to 20% for durable medical equipment, prosthetics, and medical supplies, and prior authorization is required. While diabetic therapeutic shoes and inserts are covered at a 20% coinsurance, diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
SCAN Classic Texas (HMO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Diagnostic procedures and therapeutic radiological services require a $30 copay, diagnostic radiological services are available with no copay, and lab services and outpatient x-ray services are not covered.
Home Health Services See details
SCAN Classic Texas (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Cardiac Rehabilitation Services See details
SCAN Classic Texas (HMO) covers some Cardiac Rehabilitation Services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered and require a $15 copay. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
SCAN Classic Texas (HMO) 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, though a prior three-day hospital stay is not necessary, and additional days beyond day 100 are not covered.
Other Services See details
Other services covered by SCAN Classic Texas (HMO) include acupuncture with a $5.00 copay and no coinsurance for up to 20 treatments per year. Eligible members also receive over-the-counter items with a $100 allowance every three months and a qualified meal benefit, both of which have no copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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