SCAN Strive (C-SNP) Plan Details for Orange County, CA
This page provides coverage and cost details for SCAN Health Plan’s H5425-097-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this SCAN Health Plan plan (H5425-097-0) 4.5 (Good+) out of 5 stars.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Individuals must meet all Chronic or Disabling Condition SNP qualification requirements to join this C-SNP plan.
SCAN Strive Basic Plan Details
- Plan ID
- H5425-097-0
- Plan Type
- HMO C-SNP
- Plan Year
- 2025
- Premium
- $25.70/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 9,350.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced
$590.00 deductible - Supplemental Benefits
- Vision
- Availability
- Orange County, CA
- Insured By
- SCAN Health Plan
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
The following table is a summary of the most common out-of-pocket costs you will incur if you join this SCAN Health Plan plan:
Doctor's Office Visits
- Primary
- Not Covered
- Specialist
- Not Covered
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- 20% Coinsurance
- Urgent care
- 20% Coinsurance
- Ground ambulance
- 20% Coinsurance
- Inpatient hospital care
- Skilled Nursing Facility
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- 20% Coinsurance
- Routine Foot Care
- Not Covered
Chiropractic Care
- Medicare-covered chiropractic
- 20% Coinsurance
Prior Authorization Required, Referral Required - Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- Not Covered
- Outpatient group therapy
- Not Covered
- Inpatient psychiatric hospital care
Rehabilitation Services
- Physical therapy and speech and language therapy
- 20% Coinsurance
Prior Authorization Required, Referral Required - Occupational therapy
- 20% Coinsurance
Prior Authorization Required, Referral Required
Medical Equipment and Supplies
- Diabetes supplies
- Not Covered
- Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- Not Covered
- Lab services
- Not Covered
- Outpatient x-rays
- 20% Coinsurance
Prior Authorization Required, Referral Required - Diagnostic tests and procedures
- 20% Coinsurance
Prior Authorization Required, Referral Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- 20% Coinsurance
- Oral exam
- $0
- Dental x-rays
- $0
- Cleaning
- $0
- Periodontics
- Not Covered
- Endodontics
- Not Covered
- Restorative Services
- Not Covered
Hearing Aids and Services
- Fitting/evaluation
- Not Covered
- Hearing aids
- Covered
Limits may apply - Hearing exam
- Not Covered
Vision Services
- Medicare-covered eye exam
- 20% Coinsurance
- Routine eye exam
- Covered
Limits may apply - Eyewear benefits
- Eyeglasses: No
Contact Lenses: No
Eyeglass Lenses: No
Eyeglass Frames: No
Eyewear Upgrades: No - Maximum eyewear benefit:
- $2.00
Every three years
Prescription Drug Costs & Benefits
SCAN Strive includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $25.70 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before SCAN Health Plan begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, SCAN Strive has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $0.00 |
| Generic* | $0.00 | $0.00 |
| Preferred Brand | 24.00% | 25.00% |
| Non-Preferred Drug | 45.00% | 45.00% |
| Specialty Tier | 25.00% | 25.00% |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage C-SNP's in nine broad categories using a 5-star rating system. Medicare's star ratings will help you understand the quality of care and service you can expect if you join this SCAN Health Plan plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
SCAN Strive
To be eligible to enroll in SCAN Strive , you must meet these requirements:
- You are eligible for Medicare;
- You live in Orange County (the plan’s service area); and
- You have been diagnosed with one or more severe or disabling chronic conditions.
A disabling chronic condition (disease) is one that lasts one or more years and requires ongoing medical attention and/or limits activities of daily living. They include:
- Autoimmune disorders
- End-stage renal disease
- Cancer
- Cardiovascular disorders
- Hematologic disorders
- HIV/AIDS
- Chronic heart failure
- Chronic lung disorders
- Neurologic disorders
- Dementia
- Diabetes
- End-stage liver disease
- Neurologic disorders
- Stroke
- Mental health conditions
Additional C-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
Contact Us About SCAN Health Plan
| Website: | SCAN Health Plan Plan Page (opens in new tab) |
|---|---|
| Providers: | SCAN Health Plan Providers Page (opens in new tab) |
| Formulary: | SCAN Health Plan Formulary Page (opens in new tab) |
| Pharmacy: | SCAN Health Plan Pharmacy Page (opens in new tab) |
| New Member Health Plan Help: | (888)315-7226 |
| New Member Health Plan TTY: | (888)722-6889 |
| New Member Part D Help: | (888)315-7226 |
| New Member Part D TTY Users: | (888)722-6889 |
If you qualify for Medicare benefits 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.
Health Plan Compatibility
Special Needs Plans (SNPs) under Medicare Advantage typically do not work with other types of health insurance. If you have Medicare Part A or Part B and decide to join an SNP plan, you will be removed from Original Medicare. Furthermore, you cannot be enrolled in an SNP plan and hold a Medigap Insurance policy at the same time.
With a D-SNP, members keep the same Medicaid plan and Medicaid benefits. If you are a Veteran and have VA Health Benefits, you may be able to care from your local VA hospital.
Citations & References
- SCAN Health Plan, http://www.scanhealthplan.com, Last Accessed October 13, 2024
- Medicaid.gov, "Medicaid & CHIP in California", Last Accessed October 1, 2024
- CMS.gov, Landscape Source Files, Last Accessed October 2, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 2, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 5, 2024
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
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