SCAN Balance (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
- $699
- Lower than most plans here
- 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 5 other plans in Kings County that the same person could join.
What stands out
- No monthly premium
- At most $699 a year for covered care, lower than most plans here
- $90 for the emergency room, lowest of 5 plans here
- Dental: plan pays up to $3,000 a year, more than most plans here
Watch out for
- 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 care4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$165$0 in premiums + $165 for careHigher than most plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day 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 care$0
- Emergency room$90Lowest of 5 plans hereNot charged if you stay in the hospital
- Hospital stay$0Referral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0Referral neededPlan approval may be needed
- Outpatient hospital care$0 to $85Depends on the service
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0Referral neededPlan approval may be needed
- Ground ambulance$75Plan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $50 a day for days 21 to 100Referral neededPlan 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 5 other plans in Kings 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 | $5 |
| 2Generic | $0 | $15 |
| 3Preferred BrandAfter the deductible | $42 | $47 |
| 4Non-Preferred DrugAfter the deductible | 35% of the price | 35% of the price |
| 5Specialty TierAfter the deductible | 30% of the price | 30% 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 $3,000 a year.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $300 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.
- Over-the-counter items IncludedUp to $35 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 Included34 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 Balance (HMO C-SNP), plan number H5425-102, for 2026?”