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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 Harris 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 no deductible for prescription drugs. During the initial coverage phase, you'll pay no copay for preferred generic drugs, and a $42 or $43 copay for standard generic drugs, depending on the pharmacy. For preferred brand drugs, you'll pay 50% coinsurance, and for non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The SCAN MyChoice (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with the amount varying depending on the type of stay. Outpatient services, primary care, hearing, vision, and dental services all have copays, while preventive services and home health services have no copay. The plan also covers emergency services, ambulance services, and home infusion. Additionally, there is coverage for medical equipment and diagnostic services, with coinsurance or copays applying. The plan includes benefits for skilled nursing facilities, and other services such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $200 copay for days 1-2, and no copay for days 3-90, while for Inpatient Hospital Psychiatric, you pay a $200 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $15 and $150, observation services, and ambulatory surgical center services with a $15 copay. Outpatient substance abuse services and outpatient blood services are also covered, with a $15 copay for individual and group sessions for outpatient substance abuse.
Partial Hospitalization See details
Partial Hospitalization is covered by SCAN MyChoice (HMO) with a $55 copay, and requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
The SCAN MyChoice (HMO) plan covers ambulance services, including both ground and air ambulance services, each with a $225 copay and 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. Emergency Services have a $90 copay, and Urgently Needed Services have a $20 copay, while Worldwide Emergency Services have varying copays: $90 for Worldwide Emergency Coverage, $20 for Worldwide Urgent Coverage, and $225 for Worldwide Emergency Transportation. There is no coinsurance for any of these services.
Primary Care See details
The SCAN MyChoice (HMO) plan 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, routine chiropractic care has a $5 copay, and Physician Specialist Services have a $15 copay. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, Individual Sessions for Mental Health and Psychiatric Services, and Group Sessions for Mental Health and Psychiatric Services have a $15 copay. Other Health Care Professional services have a copay between $0 and $15, and additional telehealth benefits have a copay between $0 and $20. Opioid Treatment Program Services have a $15 copay.
Preventive Services See details
The SCAN MyChoice (HMO) plan covers preventive services, including annual physical exams, with no copay. The plan also covers health education, Personal Emergency Response System (PERS), In-Home Support Services, support for caregivers, fitness benefits, and remote access technologies. However, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, home and bathroom safety devices, 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 with no copay. Prescription hearing aids are covered with a copay between $550 and $850, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
SCAN MyChoice (HMO) covers vision services including routine eye exams with a $15 copay and eyewear, including contact lenses, eyeglasses, and eyeglass lenses and frames. Eyewear has a combined maximum benefit of $250 every two years, and upgrades are not covered.
Dental Services See details
The SCAN MyChoice (HMO) plan covers dental services, including oral exams (2 visits per year), dental x-rays (1 per year), other diagnostic dental services, and prophylaxis (cleaning) (2 visits per year). Fluoride treatment, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered. Orthodontic services are covered with a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the SCAN MyChoice (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the SCAN MyChoice (HMO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies have a coinsurance, with no copay. Diabetic Equipment has a coinsurance, with Diabetic Supplies not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The SCAN MyChoice (HMO) plan covers diagnostic and radiological services, but Lab Services and Outpatient X-Ray Services are not covered. Diagnostic Procedures/Tests have a $30 copay, Diagnostic Radiological Services have a maximum copay of $150, and Therapeutic Radiological Services have a $60 copay.
Home Health Services See details
Home Health Services are covered by the SCAN MyChoice (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by SCAN MyChoice (HMO), but the plan does not cover specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SCAN MyChoice (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20, there is no copay, but for days 21-100, the copay is $140.
Other Services See details
For Other Services, SCAN MyChoice (HMO) covers acupuncture with a $5 copay, up to 20 treatments per year, over-the-counter items with a $50 allowance every three months, and a meal benefit. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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