SCAN Embrace (I-SNP HMO) 2023 Maricopa County, Arizona Medicare Advantage Special Needs Plan
SCAN Embrace, by SCAN Desert Health Plan, is a 2023 Medicare Advantage Special Needs Plan (HMO I-SNP) available in Maricopa County, Arizona. Delivery of healthcare services and costs are significantly different than in Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., and the plan offers additional benefits that are not included with Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B.
This plan has not been rated by CMS.
Key Takeaways
- This is a non-government HMO health plan for people who are institutionalized.
- If you enroll, SCAN Embrace replaces your Medicare Part A and Part B (Original Medicare) with equal hospitalization and medical benefits, but your costs will be different (see "Health Plan Costs & Benefits" below).
- To qualify, you must be enrolled in both Medicare Part A and Part B. Additionally, you must live in the Maricopa County service area, and you must live in a skilled nursing institution or require skilled nursing care at home.
- SCAN Embrace includes a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan for outpatient prescription drug coverage, as well as other benefits not covered by Medicare Part A and Part B.
- The Part D plan does not have an annual deductible. Cost-sharing begins with your first prescription.
- If you qualify for Medicare's "Extra Help" program, financial assistance is available to help pay your Medicare Part D monthly premium, annual deductible, and copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. at the pharmacy.
- If you don't qualify, be sure to look at the traditional Medicare Advantage plans available in Maricopa County, Arizona.
| Plan Basics | |
|---|---|
| Plan ID: | H1822-005-0 |
| Plan Type: | I-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $0.00/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $1,500 In-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get... |
| Drug Plan Benefit: | Enhanced $0.00 deductible |
| Rx Gap Coverage: | Yes |
| Supplemental Benefits: | None |
| Availability: | Maricopa County, AZ |
| Insured By: | SCAN Desert Health Plan |
Health Plan Costs & Benefits
SCAN Embrace is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, SCAN Embrace does allow out-of-network care for emergencies and out-of-area dialysis.
PremiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.
Monthly Premium
SCAN Embrace's total monthly premium in Maricopa County is $0.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above....
Annual Deductible
SCAN Embrace's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.
Maximum Out-of-Pocket Limit
The Maximum Out-of-Pocket (MOOP) with this SCAN Desert Health Plan plan is $1,500 in-network. Unlike Original Medicare, Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. you will incur if you join this SCAN Desert Health Plan plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $1,500 In-network |
| Doctor Visits | |
| Specialist | $0 copay (referral required, authorization required) |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient group therapy visit | $0 copay (referral required, authorization required) |
| Outpatient individual therapy visit | $0 copay (referral required, authorization required) |
| Outpatient group therapy visit with a psychiatrist | $0 copay (referral required, authorization required) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay (referral required, authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit | $0 copay (referral required, authorization required) |
| Medical Equipment / Supplies | |
| Prosthetics (e.g., braces, artificial limbs) | 0-20% coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. per item (authorization required) |
| Durable medical equipmentDurable medical equipment (DME) is equipment that is designed to last and can be used repeatedly. It is suitable for home use and includes wheelchairs, oxygen equipment, and hospital beds. (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Outpatient x-rays | $0 copay (referral required, authorization required) |
| Diagnostic tests and procedures | $0 copay (referral required, authorization required) |
| Lab services | $0 copay (referral required, authorization required) |
| Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. Drugs | |
| Other Part B drugs | 0-20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | $0 copay (referral required, authorization required, limits may apply) |
| Hearing | |
| Hearing aids | $450-750 copay (limits may apply) |
| Fitting/evaluation | $0 copay (referral required, authorization required) |
| Preventive Dental | |
| Fluoride treatment | Not covered |
| Dental x-ray(s) | $0 copay (limits may apply) |
| Oral exam | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Extractions | $0-140 copay (referral required, authorization required) |
| Endodontics | $5-395 copay (referral required, authorization required) |
| Diagnostic services | $0-5 copay (referral required, authorization required) |
| Non-routine services | $0-125 copay (referral required, authorization required) |
| Periodontics | $0-380 copay (referral required, authorization required) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $13-395 copay (referral required, authorization required) |
| Vision | |
| Eyeglass lenses | $0 copay (referral required, authorization required, limits may apply) |
| Eyeglasses (frames and lenses) | $0 copay (referral required, authorization required, limits may apply) |
| Contact lenses | $0 copay (referral required, authorization required, limits may apply) |
| Eyeglass frames | $0 copay (referral required, authorization required, limits may apply) |
| Other | Not covered |
| Routine eye exam | $0 copay (referral required, authorization required, limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $120 copay per visit (always covered) |
| Ground ambulance | $200 copay |
| Inpatient hospital coverage | $150 per day for days 1 through 5 $0 per day for days 6 through 90 |
| Outpatient hospital coverage | $0-100 copay per visit |
| Skilled Nursing Facility | $0 copay |
| Optional supplemental benefits | Yes |
Feel free to download our SCAN Embrace Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
SCAN Embrace includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Enhanced plans generally have higher monthly premiums than basic benefit plans but offer more benefits. For example, many enhanced PDPs do not have an annual deductible, may offer additional coverage during the coverage gap (aka, "donut hole"), and may have a broader list of supported drugs, known as a formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.. Some enhanced PDPs even cover excluded drugs. It's important to remember that benefits vary from plan to plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $0.00 |
| Part D Premium with 50% LIS Assistance: | $0.00 |
| Part D Premium with 25% LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before SCAN Desert Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, SCAN Embrace has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Tier | Preferred | Standard |
|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay |
| 2 (Generic) | $0.00 copay | $0.00 copay |
| 3 (Preferred Brand) | $37.00 copay | $37.00 copay |
| 4 (Non-Preferred Drug) | $99.00 copay | $100.00 copay |
| 5 (Specialty Tier) | 33% | 33% |
A Brief Review and CMS 5-Star Rating Marks
The table below shows the quality ratings for this SCAN Desert Health Plan plan. Each year CMS rates Medicare Special Needs Plans in nine broad categories. We do not recommend joining a plan with an overall rating of less than 3.0 (3 stars).
This plan too new to have a star rating from Medicare. But we can give you our take on SCAN Embrace's value.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
How to Qualify to Enroll in
SCAN Embrace
To be eligible to enroll in SCAN Embrace, you must meet three requirements:
- You are eligible for Medicare;
- You live in Maricopa County (the plan’s service area); and
- You require the level of care provided in an institutionalized setting, such as a long-term carea variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including... nursing facility, for 90 days or more.
If you live at home and require an equivalent level of skilled care, you may be eligible for an Institutional Equivalent Special Needs Plan (IE-SNP).
Before joining SCAN Embrace, consider these questions:
- Does the plan's provider network include my nursing home or home care provider?
- What costs should I expect with my coverage (premiums, deductibles, copayments)?
- Is there an annual limit on my out-of-pocket costs?
- Will I be able to use my doctors? Are they in the plan's network?
- Are the plan's in-network providers and facilities in convenient locations?
- Does the plan provide coverage for services I receive from out-of-network providers?
- Do I need a referral to see a specialist?
- Are my medications on the Part D plan's formulary?
- What special accommodations does the plan make for persons with disabilities?
- What special language and cultural accommodations does the plan make?
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans in Maricopa County (I-SNPs) that might be worth reviewing:
Contact SCAN Desert Health Plan
| Plan Website: | http://www.scanhealthplan.com |
|---|---|
| Formulay Information: | https://www.scanhealthplan.com/ |
| Pharmacy Information: | SCAN Desert Health Plan Pharmacy Page |
| Prospective Members: | (888)315-7226 |
| TTY Users: | (711)- |
If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Citations & References
- SCAN Desert Health Plan, http://www.scanhealthplan.com, Last Accessed October 13, 2022
- MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States..gov, "Medicaid & CHIP in Arizona", Last Accessed October 15, 2022
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed June 29, 2022
- CMS.gov, Landscape Source Files, Last Accessed October 26, 2021
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 6, 2021
- CMS.gov, Plan Benefits Package, Last Accessed October 4, 2021
The Medicare Special Needs Plans in Maricopa County, Arizona for 2023 information on this page was last updated on .