SCAN MyChoice (HMO)
SCAN Health Plan · HMO · 2026 coverage
In 2027, this plan merges into another plan
Members move into SCAN Classic (HMO) unless they choose another plan by December 7. Read your letter: doctors, drugs and costs may be different.
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
- $1,299
- Lower than most plans here
- Drug deductible
- $250
- Higher than most plans here
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- 4 of 5
In plain English
Compared with the 25 other plans in Santa Clara County that the same person could join.
What stands out
- No monthly premium
- At most $1,299 a year for covered care, lower than most plans here
- $150 for a 5-day hospital stay, lower than most plans here
- $90 for the emergency room, lower than most plans here
Watch out for
- $250 drug deductible, higher than most plans here
- You need a referral to see a specialist
- Covers only the plan’s own doctors and hospitals, except in an emergency or for urgent care
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$535$0 in premiums + $535 for careLower 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.Uses the highest listed cost for: MRI, CT and other scans.
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$90Lower than most plans hereNot charged if you stay in the hospital
- Hospital stay$50 a day for days 1 to 3, then $0 for days 4 to 90Lower than most plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral neededPlan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center$0 to $50Depends on the serviceReferral neededPlan approval may be needed
- Outpatient hospital care$0 to $100Depends on the service
- X-rays$0Referral neededPlan approval may be needed
- MRI, CT and other scans$0 to $100Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$95Lower than most plans herePlan 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
- Mental health therapy visit$10Referral neededPlan approval may be needed
- Psychiatrist visit$10Referral neededPlan approval may be needed
- Physical or speech therapy$0Referral neededPlan approval may be needed
- Occupational therapy$0Referral neededPlan approval may be needed
- Home health care$0Referral neededPlan approval may be needed
- Medical equipment, like a walker or oxygen0% to 20%Depends on the servicePlan approval may be needed
- Kidney dialysis20%Referral neededPlan approval may be needed
- Chemotherapy and radiation drugs0% to 20%Depends on the servicePlan approval may be needed
- Other drugs given at a clinic0% to 20%Depends on the servicePlan approval may be needed
- Heart rehab$15Higher than most plans hereReferral neededPlan approval may be needed
- Foot doctor (podiatrist)$0
- Chiropractor$0Referral 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 25 other plans in Santa Clara County that the same person could join. Ask the plan for its 2026 Evidence of Coverage booklet for the full rules.
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Add your doctors once. We’ll check them against each plan you look at.
Before you choose, call each doctor’s office and ask:
“Do you take SCAN MyChoice (HMO), plan number H5425-120, for 2026?”
What medicines cost
The most you pay for covered drugs in 2026 is $2,100. After that, covered drugs cost $0 for the rest of the year.
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $0 |
| 2Generic | $0 | $0 |
| 3Preferred BrandAfter the deductible | $42 | $43 |
| 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 $245 every three months.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $245 every three months.
- Hearing IncludedHearing test: $0. Hearing aids covered.
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
- Meals IncludedMeals for a short time, right after surgery or a hospital stay, when a health problem keeps you at home or for a long-term illness.
- Help at home IncludedIncludes help at home with everyday tasks, support for family caregivers and an emergency call button.Ask the plan who can get it.
- Other extras IncludedIncludes a nurse phone line or online visits, health classes and acupuncture.
Help paying for this plan
Programs that can lower your Medicare costs if your income is limited.
Extra Help with drug costs
The drug part of this plan’s premium is already $0, so Extra Help would not lower the premium.
Extra Help also lowers what you pay for each medicine.
See who can get Extra HelpHelp with your Part B premium
A Medicare Savings Program can pay your Part B premium, and for some people more of their Medicare costs.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(888) 315-7226 · TTY (888) 722-6889
- Plan websitewww.scanhealthplan.com
From the details the plan filed with Medicare for 2026. To check whether a doctor takes this plan, call the doctor’s office, not the plan.