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SCAN Balance (HMO C-SNP)

Health Insurance Company: SCAN Health Plan

Medicare Advantage Plan Details

Chronic Condition (C-SNP)

SCAN Health Plan
$0 /mo
monthly premium
SCAN Balance (HMO C-SNP)
Additional Coverage
Overall Star Rating (2025)
  • Rx
  • Dental
  • Vision
  • Hearing
3.5
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$2000
Rx Drug Coverage
Yes
Rx Deductible
$0
Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$0 copay

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Transportation for non-emergency
Yes
Fitness Benefits
Yes
Worldwide emergency
Yes
Telehealth
Yes
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
$0 copay
Specialist Office Visit
$0 copay
Periodic Exam Coverage
$0 copay

Emergency Room

$90 copay per visit (always covered)

Ambulance Coverage

$250 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: $0 copay
Medicare-covered lab services: $0 copay
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): $0-200 copay
Medicare-covered x-ray services: $0 copay

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: $0 copay

Hospitalization Coverage

Inpatient hospital-acute:
$75 per day for days 1 through 5
$0 per day for days 6 through 90
Inpatient hospital psychiatric:
$200 per day for days 1 through 7
$0 per day for days 8 through 90

Rehabilitation Coverage

Occupational therapy services:
$0-10 copay
Physical therapy and speech and language therapy services:
$0-10 copay

Urgent Care Coverage

$0 copay

Skilled Nursing Facility (SNF)

$0 per day for days 1 through 20
$150 per day for days 21 through 100

Mental Health Coverage

Medicare-covered individual sessions: $0-20 copay
Medicare-covered group sessions: $0-20 copay

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays:
In-network: $0 copay
Out-of-network: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: $0 copay
Eyewear:
Contact Lenses: $0 copay
Eyeglasses: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: $0 copay
Hearing aids:
Hearing aids (all types): $550-850 copay

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$42.00 copay (30-day supply)
$126.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$5.00 copay (30-day supply)
$10.00 copay (90-day supply)

Tier 2: Generic

$9.00 copay (30-day supply)
$18.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Tier 1: Preferred Generic

$5.00 copay (30-day supply)
$10.00 copay (90-day supply)

Tier 2: Generic

$9.00 copay (30-day supply)
$18.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$42.00 copay (30-day supply)
$126.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

50% coinsurance (30-day supply)
50% coinsurance (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

More Additional Benefits

Annual physical exams
Yes
Chiropractic Coverage
Yes
Acupuncture
Yes
Massage Therapy
No
Health Education
Yes
Counseling Services
No
Support for Caregivers of Enrollees
Yes
Personal Emergency Response System (PERS)
Yes
In-home support services
Yes
Home and bathroom safety devices
No
Meals for short duration
Yes

Plan Links

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Additional Plan Info

Plan Year:
2025
Insurance Company Website:
SCAN Health Plan

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following insurance companies:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Anthem Blue Cross
  • Anthem Blue Cross and Blue Shield
  • Aspire Health Plan
  • Baylor Scott & White Health Plan
  • Capital Blue Cross
  • Cigna Healthcare
  • Dean Health Plan
  • Devoted Health
  • Florida Blue Medicare
  • Freedom Health
  • GlobalHealth
  • Health Care Service Corporation
  • Healthy Blue
  • HealthSun
  • Humana
  • Molina Healthcare
  • Mutual of Omaha
  • Medica Central Health Plan
  • Optimum HealthCare
  • Premera Blue Cross
  • SCAN Health Plan
  • Simply
  • UnitedHealthcareⓇ
  • Wellcare
  • WellPoint