SCAN Connections at Home (D-SNP) Plan Details for Riverside County, CA
This page provides coverage and cost details for SCAN Health Plan’s H0976-002-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*This plan is new and has not yet been rated by CMS.
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 Dual-Eligible SNP qualification requirements to join this D-SNP plan.
SCAN Connections at Home Basic Plan Details
- Plan ID
- H0976-002-0
- Plan Type
- HMO D-SNP
- Plan Year
- 2025
- Premium
- $0.00/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, Hearing
- Availability
- Riverside 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
- $0 Copay
- Specialist
- $0 Copay
Prior Authorization Required, Referral Required
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $0 Copay
- Urgent care
- $0 Copay
- Ground ambulance
- $0 Copay
- Inpatient hospital care
- Skilled Nursing Facility
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $0 Copay
- Routine Foot Care
- $0 Copay
Chiropractic Care
- Medicare-covered chiropractic
- $0 Copay
Prior Authorization Required, Referral Required - Routine chiropractic
- $0 Copay
Prior Authorization Required, Referral Required
Mental Health Services
- Outpatient individual therapy
- $0 Copay
- Outpatient group therapy
- $0 Copay
- Inpatient psychiatric hospital care
Rehabilitation Services
- Physical therapy and speech and language therapy
- $0 Copay
Prior Authorization Required, Referral Required - Occupational therapy
- $0 Copay
Prior Authorization Required, Referral Required
Medical Equipment and Supplies
- Diabetes supplies
- $0 Copay
Prior Authorization Required - Durable medical equipment
- $0 Copay
Prior Authorization Required - Prosthetics
- $0 Copay
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $0 Copay
Prior Authorization Required, Referral Required - Lab services
- $0 Copay
Prior Authorization Required, Referral Required - Outpatient x-rays
- $0 Copay
Prior Authorization Required, Referral Required - Diagnostic tests and procedures
- $0 Copay
Prior Authorization Required, Referral Required
Medicare Part B Drugs
- Chemotherapy
- $0 Copay
- Other Part B drugs (Medicare-covered)
- $0 Copay
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
- Covered
Limits may apply - Hearing aids
- Covered
Limits may apply - Hearing exam
- Covered
Limits may apply
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 Connections at Home 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: | $7.80 |
| 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 Connections at Home 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 | $1.00 |
| Preferred Brand | 25.00% | 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 CMS rates Medicare Special Needs Plans in nine broad categories based on a 5-star system. The table below shows the quality ratings for this SCAN Health Plan plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 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 Connections at Home
To qualify for enrollment in SCAN Connections at Home in Riverside County, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below California's state thresholds.
Before enrolling in SCAN Connections at Home , or any other dual-eligible SNP, be sure to ask the following questions:
- What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
- 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 if I can't afford my medications?
- What special accommodations does the plan make for persons with disabilities?
- Does the plan offer free meal delivery after a stay in the hospital?
- What help is offered for caregivers? Is adult day care covered?
- Does the plan offer a prepaid card for over the counter medications and covered groceries?
Additional D-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
Medicare Advantage Special Need Plans are not compatible with most other forms of health insurance. If you have Medicare Part A and/or Medicare Part B and join a SNP plan, you will be disenrolled from Original Medicare. You cannot simultaneously enroll in an SNP plan and Medicare Supplement Insurance.
With a D-SNP, members retain their existing Medicaid plan and benefits. Veterans who have VA Health Benefits may also be able to receive care at their 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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