SCAN DaVita Dialysis Care (HMO-POS C-SNP)
VillageHealth · HMO-POS 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
- $2,950
- Drug deductible
- $370
- 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 37 other plans in San Bernardino County that the same person could join.
What stands out
- No monthly premium
Watch out for
- $1,500 for a 5-day hospital stay, higher than most plans here
- $150 for the emergency room, tied for highest here
- $30 for urgent care, highest of 32 plans here
- Dental: plan pays up to $1,500 a year, less 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$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$50$0 in premiums + $50 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$2,250$0 in premiums + $2,250 for careHighest of 38 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$0
- Urgent care$30Highest of 32 plans here
- Emergency room$150Tied for highest here
- Hospital stay$300 a day for days 1 to 6, then $0 for days 7 to 90Higher than most plans herePlan approval may be needed
- Lab tests$0
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$0
- Outpatient hospital care$250Highest of 18 plans here
- X-rays$20Highest of 31 plans here
- MRI, CT and other scans$150Highest of 23 plans here
- Ground ambulance$300Highest of 19 plans here
- Skilled nursing facility$0 for days 1 to 20, then $200 a day for days 21 to 100Plan 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 37 other plans in San Bernardino County that the same person could join. Ask the plan for its 2027 Evidence of Coverage booklet for the full rules.
What medicines cost
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $7 |
| 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 | 29% of the price | 29% of the price |
For a 1-month supply. The $370 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 $1,500 a year.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eyewear: plan pays up to $200 a year.
- Hearing Not included
- Over-the-counter items Not included
- 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 SCAN DaVita Dialysis Care (HMO-POS C-SNP), plan number H5943-005, for 2027?”