2018 SCAN Classic II (HMO) H5425-64-0 in CA from Scan Health Plan | HealthPocket
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SCAN Classic II (HMO)

$24/mo
Summary of BenefitsCovered Drugs

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Zip Code90011
Applicant12/18/1983 Male
Coverage Start12/19/2018
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderScan Health Plan
Plan IDH5425-64-0
Plan Year2018
CMS Rating
Plan TypeHMO
Annual Deductible$0.00
What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2019. see plan
Why We Like This Plan
  • has both Health and Drug Coverage
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Costs and Other Important Information

Plan Year2018
Optional Supplemental BenefitsYes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$4,000 In-network
Other health plan deductibles?No
Health Plan Deductible$0
Monthly Drug Plan Premium$0.00
Monthly Health Plan Premium$24.00

Benefits

SERVICECOST
Inpatient hospital coverage$250 for days 1 through 6
$0 for days 7 through 90
Outpatient hospital coverage$0-150 per visit
Doctor visitsPrimary:
$0 copay
Specialist:
$0 copay
Preventive care$0 copay
Emergency care/Urgent careEmergency:
$80 per visit (always covered)
Urgent care:
$0 copay
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
$0 copay
Lab services:
$0 copay
Diagnostic radiology services (e.g., MRI):
$110
Outpatient x-rays:
$0 copay
Mental health services$250 for days 1 through 6
$0 for days 7 through 90
Outpatient group therapy visit with a psychiatrist:
$0 copay
Outpatient individual therapy visit with a psychiatrist:
$0 copay
Outpatient group therapy visit:
$30
Outpatient individual therapy visit:
$30
Skilled Nursing Facility$0 for days 1 through 20
$100 for days 21 through 100
Rehabilitation servicesOccupational therapy visit:
$10
Physical therapy and speech and language therapy visit:
$10
Ambulance$230
Transportation$0 copay
Foot care (podiatry services)Foot exams and treatment:
$0 copay
Routine foot care:
$0 copay
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
$0 copay
Prosthetics (e.g., braces, artificial limbs):
$0 copay
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:
20%
Other Part B drugs:
20%

Coverage Area for SCAN Classic II (HMO)

StateCalifornia
CountyLos Angeles

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$5 copayNot offered
Tier 2: Non-Preferred Generic$5 copay$10 copayNot offered
Tier 3: Preferred Brand Name$42 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$95 copay$100 copayNot offered
Tier 5: Specialty Tier33% coinsurance33% coinsuranceNot offered
60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$10 copayNot offered
Tier 2: Non-Preferred Generic$10 copay$20 copayNot offered
Tier 3: Preferred Brand Name$84 copay$94 copayNot offered
Tier 4: Non-Preferred Brand Name$190 copay$200 copayNot offered
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$0 copayNot offered
Tier 2: Non-Preferred Generic$10 copay$20 copayNot offered
Tier 3: Preferred Brand Name$116 copay$131 copayNot offered
Tier 4: Non-Preferred Brand Name$275 copay$290 copayNot offered
Tier 5: Specialty Tier

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physicians that accept SCAN Classic II (HMO) for California

AARP MedicareComplete SecureHorizons Essential (HMO)
COST:from $0CMS Rating:
Select
Health Net Seniority Plus Green (HMO)
COST:from $0CMS Rating:
Select
Alignment Health Plan My Choice (HMO)
COST:from $0CMS Rating:
Select
SCAN Classic (HMO)
COST:from $0CMS Rating:
Select
Humana Gold Plus H5619-015 (HMO)
COST:from $0CMS Rating:
Select

Health Benefits

Types of Health Insurance

Health Insurance

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.