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SCAN Embrace (I-SNP) H5425 087 0 Plan Details

This page provides coverage and cost details for SCAN Health Plan’s H5425-087-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.

CMS 2025 Rating: ☆☆☆☆☆*

*CMS rated this SCAN Health Plan plan (H5425-087-0) 4.5 (Good+) out of 5 stars.

Best Insurance Company Ranking
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The SCAN Health Plan logo is a registered trademark.[2] Its use by MedicareWire is strictly for editorial purposes. This is not a solicitation of insurance.

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 Institutional SNP qualification requirements to join this I-SNP plan.

SCAN Embrace Basic Plan Details

Plan ID
H5425-087-0
Plan Type
HMO I-SNP
Plan Year
2025
Premium
$0.00/mo
Plus your Medicare Part B premium.
Health Plan Deductible
$0.00
Out-of-Pocket Maximum
799.00 /yr (in-network)
Part B Reduction
$0.00/mo
Drug Plan Benefit
Enhanced
$0.00 deductible
Supplemental Benefits
Vision, Hearing
Availability
See List
Insured By
SCAN Health Plan

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
$90 Copay
Urgent care
Not Covered
Ground ambulance
$95 Copay
Inpatient hospital care
Coming Soon
Skilled Nursing Facility
Unknown

Foot Care

Foot Exams and Treatments (Medicare-covered)
Not Covered
Routine Foot Care
Not Covered

Chiropractic Care

Medicare-covered chiropractic
Not Covered
Routine chiropractic
Not Covered

Mental Health Services

Outpatient individual therapy
Not Covered
Outpatient group therapy
Not Covered
Inpatient psychiatric hospital care
Coming Soon

Rehabilitation Services

Physical therapy and speech and language therapy
Not Covered
Occupational therapy
Not Covered

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
$75 Copay
Prior Authorization Required, Referral Required
Lab services
Not Covered
Outpatient x-rays
Not Covered
Diagnostic tests and procedures
Not Covered

Medicare Part B Drugs

Chemotherapy
20% Coinsurance
Other Part B drugs (Medicare-covered)
20% Coinsurance

Dental Services

Medicare Covered Preventive Dental
Not Covered
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
Not Covered
Hearing exam
Covered
Limits may apply

Vision Services

Medicare-covered eye exam
Routine eye exam
Covered
Limits may apply
Eyewear benefits
None

Prescription Drug Costs & Benefits

SCAN Embrace 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: $0.00
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 $0.00. 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 Embrace 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$42.00$43.00
Non-Preferred Drug50.00%50.00%
Specialty Tier33.00%33.00%
*The Part D deductible does not apply.

How to Qualify to Enroll in
SCAN Embrace

To be eligible to enroll in SCAN Embrace, you must meet three requirements:

  1. You are eligible for Medicare;
  2. You live in Orange County (the plan’s service area); and
  3. You require the level of care provided in an institutionalized setting, such as a long-term care 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?