SCAN Heart First (HMO C-SNP) is a Medicare Advantage (Part C) Special Needs Plan by SCAN Health Plan.
This page features plan details for 2024 SCAN Heart First (HMO C-SNP) H5425 – 028 – 0 available in Los Angeles and Orange Counties.
IMPORTANT: This page has been updated with plan and premium data for 2024.
SCAN Heart First (HMO C-SNP) is offered in the following locations.
SCAN Heart First (HMO C-SNP) offers the following coverage and cost-sharing.
Special Needs Plan Type: | Chronic or Disabling Condition |
Conditions Covered: | Cardiovascular Disorders and Chronic Heart Failure |
Insurer: | SCAN Health Plan |
Health Plan Deductible: | $0.00 |
MOOP: | $199 In-network |
Drugs Covered: | Yes |
Ready to sign up for SCAN Heart First (HMO C-SNP) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $0.00 | $0.00 | $0.00 | $174.70 |
SCAN Heart First (HMO C-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced |
Additional Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$0.00 | $0.00 |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $5.00 copay | $0.00 copay | $5.00 copay |
2 (Generic) | $0.00 copay | $9.00 copay | $0.00 copay | $9.00 copay |
3 (Preferred Brand) | $35.00 copay | $47.00 copay | $35.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $95.00 copay | $100.00 copay | $95.00 copay | $100.00 copay |
5 (Specialty Tier) | 33% | 33% | 33% | 33% |
6 (Select Care Drugs) | $0.00 copay | $0.00 copay | $0.00 copay | $0.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) | ||||
6 (Select Care Drugs) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $10.00 copay | $0.00 copay | $10.00 copay |
2 (Generic) | $0.00 copay | $18.00 copay | $0.00 copay | $18.00 copay |
3 (Preferred Brand) | $85.00 copay | $121.00 copay | $85.00 copay | $121.00 copay |
4 (Non-Preferred Drug) | $265.00 copay | $280.00 copay | $265.00 copay | $280.00 copay |
5 (Specialty Tier) | ||||
6 (Select Care Drugs) | $0.00 copay | $0.00 copay | $0.00 copay | $0.00 copay |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $5.00 copay | $0.00 copay | $5.00 copay |
2 (Generic) | $0.00 copay | $9.00 copay | $0.00 copay | $9.00 copay |
Generic drugs | ||||
Brand-name drugs |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $10.00 copay | $0.00 copay | $10.00 copay |
2 (Generic) | $0.00 copay | $18.00 copay | $0.00 copay | $18.00 copay |
Generic drugs | ||||
Brand-name drugs |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced benefit type.
SCAN Heart First (HMO C-SNP) also provides the following benefits.
$0 |
In-network | No |
$199 In-network |
Yes |
In-network | No |
$0 copay (Authorization is required.) (Referral is required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $0 copay (Authorization is required.) (Referral is required.) |
$0 copay (Authorization is required.) (Referral is required.) |
Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $0 copay (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0 copay (Authorization is required.) (Referral is required.) |
Lab services | $0 copay (Authorization is required.) (Referral is required.) |
Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient x-rays | $0 copay (Authorization is required.) (Referral is required.) |
Hearing exam | $0 copay (Authorization is required.) (Referral is required.) |
Fitting/evaluation | $0 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Hearing aids | $450-750 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | $0-125 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
Diagnostic services | $0-5 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
Restorative services | $8-395 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
Endodontics | $5-395 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
Periodontics | $0-380 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
Extractions | $0-140 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
Prosthodontics, other oral/maxillofacial surgery, other services | $13-395 copay (There are no limits.) (Authorization is required.) (Referral is not required.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Eyeglass frames | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is required.) (Referral is required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
Physical therapy and speech and language therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
$100 copay (Not applicable.) (Not applicable.) |
$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Foot exams and treatment | $0 copay (Authorization is not required.) (Referral is not required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Durable medical equipment (e.g., wheelchairs, oxygen) | $0 copay (Authorization is required.) (Not applicable.) |
Prosthetics (e.g., braces, artificial limbs) | $0 copay (Authorization is required.) (Not applicable.) |
Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
$0 copay (Authorization is required.) (Referral is required.) |
Inpatient hospital – psychiatric | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient group therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
Outpatient individual therapy visit | $0 copay (Authorization is required.) (Referral is required.) |
$0 copay (Authorization is required.) (Referral is required.) |
Monthly Premium | $42.00 |
Deductible | nan |
Preventive dental: | Monthly Premium: | $42.00 |
Preventive dental: | Deductible: | N/A |
Comprehensive dental: | Monthly Premium: | $42.00 |
Comprehensive dental: | Deductible: | N/A |
Ready to sign up for SCAN Heart First (HMO C-SNP) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
HealthCompare Insurance Services does not offer every plan available in your area. Currently we represent 18 organizations, which offers 52,101 products in your area.
We do not feature every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Enrollment is offered through our partners including HealthCompare Insurance Services Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Medicare has neither approved nor endorsed any information on this site.