Health Education
Cost not publishedMandatory
IncludedSCAN Balance (HMO C-SNP)
SCAN Health Plan
HMO C-SNPChronic or Disabling ConditionSanta Clara CountyIncludes Part DPlan year 2026
$0/momonthly premium
$750most you pay in-network per year
4overall CMS star rating
782members enrolled, January 2026
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
In-network out-of-pocket maximum$750
Plan premium, per month$0
What a year on this plan would likely cost
What you pay for care
In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.
Hospital stays
Inpatient psychiatric stay
Days 1–4$0 per day
Days 5–10$75 per day
Days 11–90$0 per day
Skilled nursing facility stay
Days 1–20$0 per day
Days 21–100$50 per day
Emergency and urgent care
Emergency room visit
$90
Copay
Emergency care outside the U.S.
$90
Copay
Emergency transportation outside the U.S.
$100
Copay
Mental health and substance use
Individual therapy session
$10
Copay
Group therapy session
$10
Copay
Opioid treatment program
$10
Copay
Partial hospitalization program
$55
Copay
Prior authorization required
Tests, labs and imaging
Diagnostic radiology (MRI, CT, PET)
$0–$100
Copay, depends on the service
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
$0–$100
Copay, depends on the service
Ambulance
Ground ambulance
$100
Copay
Air ambulance
$100
Copay
Medical equipment and supplies
Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
0–20%
Coinsurance, depends on the service
Prosthetic devices
0–20%
Coinsurance, depends on the service
Dialysis
Dialysis
20%
Coinsurance — your share of the bill
Part B drugs
Part B drugs
0–20%
Coinsurance, depends on the service
Chemotherapy drugs
0–20%
Coinsurance, depends on the service
Part B insulin
0–20%
Coinsurance, depends on the service
Never more than $35 for a one-month supply
Vision
Eyewear allowance
Up to $250 per year
Allowance
Hearing
Prescription hearing aids
$550–$850
Copay, depends on the service
Extra benefits
Over-the-counter items
Up to $50 per month
Allowance
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
In-Home Safety Assessment
Cost not publishedMandatory
IncludedPersonal Emergency Response System (PERS)
Cost not publishedMandatory
IncludedIn-Home Support Services
Cost not publishedMandatory
IncludedSupport for Caregivers of Enrollees
Respite Care; Caregiver Training
Cost not publishedMandatory
IncludedFitness Benefit
Physical Fitness; Memory Fitness
Cost not publishedMandatory
IncludedRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
Nursing Hotline; Web/Phone-based technologies
Cost not publishedMandatory
IncludedNot offered by this plan
Medical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesNutritional/Dietary BenefitHome-Based Palliative CareAdditional Sessions of Smoking and Tobacco Cessation CounselingEnhanced Disease ManagementTelemonitoring ServicesHome and Bathroom Safety Devices and ModificationsCounseling Services
Dental
No dental deductible.
Preventive
Oral examsMandatory
CleaningsMandatory
X-raysMandatory
Other diagnostic servicesMandatory
Comprehensive
Restorative (fillings)Mandatory
Endodontics (root canals)Mandatory
Periodontics (gum treatment)Mandatory
Oral surgeryMandatory
Adjunctive general servicesMandatory
Prescription drugs (Part D)
$250 annual drug deductible · 5 formulary tiers · mail order available. Costs shown for a 30-day supply.
Before the deductible
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | $5 copay | No copay | — | Waived |
| 2. Generic | No copay | $10 copay | No copay | — | Waived |
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | $5 copay | No copay | — | Waived |
| 2. Generic | No copay | $10 copay | No copay | — | Waived |
| 3. Preferred Brand | $42 copay | $47 copay | $42 copay | $0 | Applies |
| 4. Non-Preferred Drug | 35% coinsurance | 35% coinsurance | 35% coinsurance | $35 | Applies |
| 5. Specialty Tier specialty | 30% coinsurance | 30% coinsurance | 30% coinsurance | — | Applies |
Catastrophic (after the out-of-pocket threshold)
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | No copay | — | Waived |
| 2. Generic | No copay | No copay | No copay | — | Waived |
| 3. Preferred Brand | No copay | No copay | No copay | $0 | Applies |
| 4. Non-Preferred Drug | No copay | No copay | No copay | $35 | Applies |
| 5. Specialty Tier specialty | No copay | No copay | No copay | — | Applies |
Out-of-pocket threshold for the catastrophic phase: $2,100.
Is my medicine on this plan’s list?
Pharmacies near you in this plan's network
From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.
CMS star ratings
Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.
4 out of 5Overall rating
4 out of 5Health services (Part C)
4 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
4- Annual flu vaccine4
- Breast cancer screening4
- Colorectal cancer screening4
- Monitoring physical activity5
- Improving or maintaining mental health1
- Improving or maintaining physical health4
Managing chronic (long-term) conditions
4- Readmissions4
- Kidney health5
- Blood pressure5
- Reducing falls2
- Statin therapy3
- Pain assessment5
- Bladder control2
- Medication review5
- Diabetes eye exam5
- Transitions of care3
- Diabetes blood sugar4
- Osteoporosis management4
- Followup after emergency department visit2
- Medication reconciliation4
- Special needs plan SNP care management4
Member experience with the health plan
3- Customer service3
- Care coordination2
- Healthcare quality3
- Health plan rating5
- Getting needed care2
- Getting appointments2
Member complaints and changes in the plan's performance
5- Complaints5
- Members leaving5
- Quality improvement4
Health plan customer service
4- Call center4
- Timely decisions5
- Appeals decisions4
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Drug plan complaints and changes
4- Complaints5
- Members leaving5
- Quality improvement2
Member experience with the drug plan
5- Drug plan rating5
- Prescription drugs4
Drug safety and accuracy of drug pricing
4- Price accuracy5
- Statin diabetes4
- Medication therapy management comprehensive medication review completion4
- Medication adherence for diabetes medications4
- Medication adherence for hypertension RAS antagonists s4
- Medication adherence for cholesterol statins4
Why members leave this contract
Service area and network
Sold in 2 California counties.
Santa ClaraStanislaus
Doctor directory
520 providers are named in SCAN Health Plan’s directory for this plan, dated Jul 31, 2026.
A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly. Open the carrier directory
Contract with Medicare sinceMay 1, 2005
Medicare Advantage regionCalifornia
Ask about this plan
A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.
Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.