SCAN Balance (HMO C-SNP)
SCAN Health Plan · HMO C-SNP · 2027 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
- $1,900
- Lower than most plans here
- Drug deductible
- $450
- Medicare star rating
- No rating yet
This is a special needs plan. Only some people can join: Chronic or Disabling Condition.
In plain English
Compared with the 12 other plans in San Francisco County that the same person could join.
What stands out
- No monthly premium
- At most $1,900 a year for covered care, lower than most plans here
- Dental, vision and hearing extras included
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 careTied for lowest here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$1,270$0 in premiums + $1,270 for care6 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$120Not charged if you stay in the hospital
- Hospital stay$175 a day for days 1 to 5, then $0 for days 6 to 90Referral 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$100Referral neededPlan approval may be needed
- Outpatient hospital care$175Higher than most plans here
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$50Highest of 10 plans hereReferral neededPlan approval may be needed
- Ground ambulance$175Higher than most plans herePlan approval may be needed
- Skilled nursing facility$0 for days 1 to 20, then $125 a day for days 21 to 100Referral neededPlan approval may be needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 12 other plans in San Francisco County that the same person could join. Read the plan’s 2027 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 | 28% of the price | 28% of the price |
For a 1-month supply. The $450 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 2027, 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 25%.Plan pays up to $2,000 a year.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $200 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.
- Over-the-counter items IncludedUp to $20 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 Included24 one-way rides to medical visits a year.
What changed from 2026
- Most you pay in a year2026$1,4992027$1,900
- Drug deductible2026$2502027$450
- Emergency room2026$902027$120
- Hospital stay2026$150 a day for days 1 to 5, then $0 for days 6 to 902027$175 a day for days 1 to 5, then $0 for days 6 to 90
- Outpatient hospital care2026$1252027$175
- Dental2026Cleanings and exams: $0. Fillings, crowns and dentures: you pay $0. Plan pays up to $3,000 a year2027Cleanings and exams: $0. Fillings, crowns and dentures: you pay 25%. Plan pays up to $2,000 a year
- Vision2026Yearly eye exam: $0. Glasses or contacts covered. Eyewear: plan pays up to $300 every two years2027Yearly eye exam: $0. Glasses or contacts covered. Eyewear: plan pays up to $200 a year
- Over-the-counter items2026Up to $30 a month for things like vitamins, pain relief and bandages. Unused money does not carry over2027Up to $20 a month for things like vitamins, pain relief and bandages. Unused money does not carry over
- Rides to care202628 one-way rides to medical visits a year202724 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 H5425-106, for 2027?”