A non-government entity
SCAN MyChoice Texas (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SCAN MyChoice Texas (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SCAN MyChoice Texas (HMO) in 2026, please refer to our full plan details page.
SCAN MyChoice 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 MyChoice 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 MyChoice 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 MyChoice 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 $3400.00 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 Texas (HMO) prescription drug plan features a $0 drug deductible, allowing your coverage to begin immediately. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs, whether filled for one, two, or three months at preferred, standard, or mail-order pharmacies. For Tier 3 preferred brand drugs, one-month copays start at $42 at preferred pharmacies and mail-order services, or $43 at standard pharmacies. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 35% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance for a one-month supply.
Additional Benefits
The SCAN MyChoice Texas (HMO) plan offers affordable healthcare coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $140 daily copay for days 1 through 5 and no copay for days 6 through 90, with no coinsurance required. Outpatient services and specialist visits are also highly accessible, featuring low copays ranging from $15 to $175 and no coinsurance. Emergency care is available with a $90 copay, while urgent care requires a $20 copay, both with no coinsurance. Additionally, the plan includes dental care, home-delivered meals, and over-the-counter items with no copay, alongside hearing aid coverage featuring copays between $550 and $850. Skilled nursing facility stays are also covered with no copay for the first 20 days and a $140 daily copay for days 21 through 100.
Inpatient Hospital See details
SCAN MyChoice Texas (HMO) covers inpatient hospital services with no coinsurance, requiring a $140 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under SCAN MyChoice Texas (HMO) are covered with no coinsurance, featuring copays of $15 to $175 for outpatient hospital care and $15 for ambulatory surgical center and substance abuse sessions. Outpatient blood services are covered with no copay and no coinsurance, though prior authorization and referrals are required for most services.
Partial Hospitalization See details
SCAN MyChoice Texas (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these services, and a referral may also be necessary.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by SCAN MyChoice Texas (HMO) with a $225 copay and no coinsurance for ground and air ambulance services, which require prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by SCAN MyChoice Texas (HMO) with a $90 copay and no coinsurance, with the copay waived if you are admitted to the hospital. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $90, $20, and $225 respectively.
Primary Care See details
SCAN MyChoice Texas (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $15 copay and no coinsurance. Chiropractic benefits are partially covered, offering routine care for a $5 copay and no coinsurance for up to 15 visits per year, while podiatry services are not covered.
Preventive Services See details
Preventive services are covered by SCAN MyChoice Texas (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and memory fitness benefits. The benefit is partially covered, as sub-services like in-home safety assessments, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, and home-based palliative care are not covered.
Hearing Services See details
SCAN MyChoice Texas (HMO) offers partially covered hearing services with no deductible, featuring routine hearing exams for a $15 copay and no coinsurance, and prescription hearing aids with a $550 to $850 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision Services are partially covered by SCAN MyChoice Texas (HMO) with no deductibles and no coinsurance for all covered care. Routine eye exams require a $0 to $15 copay and are limited to one per year, while eyewear has no copay up to a $240 benefit limit every three months; other eye exams and eyewear upgrades are not covered.
Dental Services See details
SCAN MyChoice Texas (HMO) offers partially covered dental services with no copay and no coinsurance, though prior authorization is required for several services. While preventive and comprehensive care like cleanings, exams, and implants are covered, other diagnostic dental services, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under SCAN MyChoice Texas (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, feature no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the SCAN MyChoice Texas (HMO) plan 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 MyChoice Texas (HMO) with no copays, as diabetic supplies are not covered. Covered durable medical equipment, prosthetics, and medical supplies require no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by SCAN MyChoice Texas (HMO) with no coinsurance, though prior authorization and referrals are required. While diagnostic radiological services have no copay, diagnostic procedures and therapeutic radiological services require a $30 copay, and lab services and outpatient x-ray services are not covered.
Home Health Services See details
SCAN MyChoice Texas (HMO) covers home health services with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under SCAN MyChoice Texas (HMO) feature no coinsurance, though only some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay. Prior authorization and a referral are also required for these services.
Skilled Nursing Facility (SNF) See details
SCAN MyChoice Texas (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring 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 inpatient hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
SCAN MyChoice Texas (HMO) provides coverage for acupuncture with a $5.00 copay and no coinsurance for up to 15 treatments per year, subject to prior authorization. Additionally, over-the-counter (OTC) items and qualifying meal benefits are covered with no copay and no coinsurance, though prior authorization is required for the meal benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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