Sutter Senior Advantage, a SCAN Medicare Plan (HMO)
SCAN Health Plan · HMO · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $49
- Higher than most plans here
- Most you pay in a year for covered care in network
- $4,900
- Higher than most plans here
- Drug deductible
- $0
- Medicare star rating
- No rating yet
In plain English
Compared with the 17 other plans in San Mateo County that the same person could join.
What stands out
- No drug deductible
- Dental, vision and hearing extras included
Watch out for
- $49 monthly premium, higher than most plans here
- Up to $4,900 a year for covered care, higher than most plans here
- $1,475 for a 5-day hospital stay, higher than most plans here
- $25 for specialist visits, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$588$588 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$703$588 in premiums + $115 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$3,043$588 in premiums + $2,455 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.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$25Higher than most plans hereReferral neededPlan approval may be needed
- Urgent care$0
- Emergency room$130Not charged if you stay in the hospital
- Hospital stay$295 a day for days 1 to 5, then $0 for days 6 to 90Higher than most plans hereReferral 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$0 to $50Depends on the serviceReferral neededPlan approval may be needed
- Outpatient hospital care$250Tied for highest here
- X-rays$15Higher than most plans hereReferral neededPlan approval may be needed
- MRI, CT and other scans$0 to $150Depends on the serviceReferral neededPlan approval may be needed
- Ground ambulance$250Plan approval may be needed
- Skilled nursing facility$10 a day for days 1 to 20, then $210 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 17 other plans in San Mateo 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 | $10 |
| 3Preferred Brand | 24% of the price | 24% of the price |
| 4Non-Preferred Drug | 30% of the price | 30% of the price |
| 5Specialty Tier | 33% of the price | 33% of the price |
For a 1-month supply. 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. Some bigger dental work included, more with an optional add-on you can buy.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $100 a year.
- Hearing IncludedRoutine hearing test covered. Hearing aids covered.
- Over-the-counter items IncludedUp to $25 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
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 Sutter Senior Advantage, a SCAN Medicare Plan (HMO), plan number H5425-148, for 2027?”