SCAN Embrace (I-SNP) H5425 091 0 Plan Details
This page provides coverage and cost details for SCAN Health Plan’s H5425-091-0 Medicare SNP plan for 2025. Enrollment is subject to eligibility.
*CMS rated this SCAN Health Plan plan (H5425-091-0) 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 Institutional SNP qualification requirements to join this I-SNP plan.
SCAN Embrace Basic Plan Details
- Plan ID
- H5425-091-0
- Plan Type
- HMO-POS 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
| 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
- $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 Drug | 50.00% | 50.00% |
| Specialty Tier | 33.00% | 33.00% |
| *The Part D deductible does not apply. | ||
5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage I-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 Embrace
To be eligible to enroll in SCAN Embrace , you must meet three requirements:
- You are eligible for Medicare;
- You live in San Bernardino County (the plan’s service area); and
- 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?
Plan Availability
SCAN Embrace (H5425-091-0) is available in the following locations (click to open):
Additional I-SNP Plan Options
Here are some additional Medicare SNP plans that might be worth reviewing:
- H5425-098-0: SCAN Strive ()
- H5425-070-0: SCAN Balance ()
- H5425-076-0: SCAN Balance ()
- H5425-086-0: SCAN Embrace ()
- H5425-104-0: SCAN Balance ()
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 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.
Plans Offered
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