SCAN Strive (HMO C-SNP)
SCAN Health Plan · HMO C-SNP · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $9,250
- Drug deductible
- $250
- Medicare star rating
- 4 of 5
This is a special needs plan. Only some people can join: Chronic or Disabling Condition.
In plain English
Compared with the 17 other plans in Madera County that the same person could join.
What stands out
- No monthly premium
- Dental: plan pays up to $4,000 a year, most of 11 plans here
Watch out for
- No hearing extra, though most plans here have one
- You need a referral to see a specialist
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$0$0 in premiums + $0 for careTied for lowest here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Not counted, because the plan charges a percentage: X-rays, Urgent care.
- A hard year$0$0 in premiums + $0 for careLowest of 18 plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Not counted, because the plan charges a percentage: Ground ambulance, Emergency room, Hospital stay.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$0Referral neededPlan approval may be needed
- Urgent care20%
- Emergency room20%
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center20%Referral neededPlan approval may be needed
- Outpatient hospital care20%
- X-rays20%Referral neededPlan approval may be needed
- MRI, CT and other scans$0Referral neededPlan approval may be needed
- Ground ambulance20%Plan approval may be needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 17 other plans in Madera County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $0 |
| 2Generic | $0 | $0 |
| 3Preferred BrandAfter the deductible | 24% of the price | 25% of the price |
| 4Non-Preferred DrugAfter the deductible | 30% of the price | 30% of the price |
| 5Specialty TierAfter the deductible | 25% of the price | 25% of the price |
For a 1-month supply. The $250 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay $0.Plan pays up to $4,000 a year.
- Vision IncludedRoutine eye exam covered. Glasses or contacts covered.Eyewear: plan pays up to $325 a year.
- Hearing Not included
- Over-the-counter items IncludedUp to $110 a month for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Included48 one-way rides to medical visits a year.
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take SCAN Strive (HMO C-SNP), plan number H5425-098, for 2026?”