2027 Medicare Advantage plan

Springs Advantage, a SCAN Medicare Plan (HMO-POS I-SNP): 2027 benefits and costs

SCAN Health Plan HMO-POS I-SNP Special Needs Plan

CMS plan ID: H3879-001-0 · Plan year: 2027

Springs Advantage, a SCAN Medicare Plan (HMO-POS I-SNP) is a 2027 Medicare Advantage plan offered by SCAN Health Plan. It is listed in Oregon.

2027 plan costs at a glance

Monthly plan premium$55.00

Drug deductible$200.00

In-network medical out-of-pocket maximum$4,000.00

Organization: SCAN Health Plan
Plan organization: SCAN HEALTH PLAN (OR)
Parent company: SCAN Group
Plan type: HMO-POS I-SNP
Part C premium: $55.00
Part D premium: $0.00
Prescription drug coverage: Yes
Special Needs Plan type: Institutional
2027 CMS Star Rating: Plan too new to be measured

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: $4,000.00
Combined in/out-of-network medical maximum: $4,000.00
Out-of-network medical maximum: Not applicable

Who can join this Special Needs Plan?

This plan has institutional care eligibility requirements. The plan must confirm your qualifying care needs or living situation before you enroll.

Plan eligibility type: Institutional
Institutional plan type: Hybrid Institutional special needs plan (HI-SNP)

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	Point-of-service	What to know
Primary care doctor	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.
Specialist visit	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required Yes
Telehealth	$0.00 to $10.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Emergency care	$90.00 copay	Not summarized. Check coverage with the plan.
Urgent care	$0	Not summarized. Check coverage with the plan.
Home health	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required Yes
Dialysis	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Not summarized. Check coverage with the plan.	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Not summarized. Check coverage with the plan.	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Medicare-covered chiropractic	$10.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required Yes Referral required No
Medicare-covered foot care	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Other health professionals	$0.00 to $10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–5: $250.00 copay per day Days 6–90: $0.00 copay per day	Approval required Yes Referral required Yes Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–5: $250.00 copay per day Days 6–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0 Service-specific deductible No
Hospital observation services	$0 Service-specific deductible No
Ambulatory surgical center	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Outpatient blood	$0 Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	Point-of-service	What to know
Diagnostic procedures and tests	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Laboratory services	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Diagnostic radiology (CT, MRI)	$0.00 to $75.00 copay Service-specific deductible No	$0.00 to $75.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Therapeutic radiology	$60.00 copay Service-specific deductible No	$60.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
X-rays	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	Point-of-service	What to know
Partial hospitalization	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Intensive outpatient program	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Substance use treatment, individual sessions	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required Yes
Substance use treatment, group sessions	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required Yes
Opioid treatment program	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required Yes
Mental health, individual sessions	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required Yes
Mental health, group sessions	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required Yes
Psychiatry, individual sessions	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required Yes
Psychiatry, group sessions	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required Yes

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$10.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Physical and speech therapy	$10.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Intensive cardiac rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Pulmonary rehabilitation	$0 Service-specific deductible No	Approval required Yes Referral required Yes
Supervised exercise for peripheral artery disease	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$95.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	$95.00 copay Service-specific deductible No	Approval required Yes
Durable medical equipment	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	$0 Service-specific deductible No	Approval required Yes
Diabetic monitors	0% to 20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	Point-of-service
Medicare-covered dental	$10.00 copay	$10.00 copay Deductible applies No Dollar benefit limit applies No
Oral examsAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
Dental X-raysAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
Other diagnostic dentalAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
Dental cleaningAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
FluorideAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
Other preventive dentalAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
Restorative dental careAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
Root canal treatment (endodontics)Additional plan benefit	$0	Not summarized. Check coverage with the plan.
Gum treatment (periodontics)Additional plan benefit	$0	Not summarized. Check coverage with the plan.
Removable dentures (prosthodontics)Additional plan benefit	$0	Not summarized. Check coverage with the plan.
Fixed dental restorations (prosthodontics)Additional plan benefit	$0	Not summarized. Check coverage with the plan.
Oral surgeryAdditional plan benefit	$0	Not summarized. Check coverage with the plan.
Other dental servicesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.

Vision benefits

Vision benefits and member costs
Service	In-network	Point-of-service	What to know
Medicare-covered eye exams	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Medicare-covered eyewear	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	Point-of-service	What to know
Medicare-covered hearing exams	$10.00 copay Service-specific deductible No	$10.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Supplemental acupunctureAdditional plan benefit	$10.00 copay Service-specific deductible No	Approval required No Referral required No
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required Yes Referral required Yes

Allowances and optional benefits

Transportation

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Transportation to plan-approved health locations; Additional Benefits for SSBCI
Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s): Transportation for non-medical needs (SSBCI: Non-Medical Transportation)
How benefits are provided: Claims Processing
Advance choice of benefits required: No
Shared limit on visits or trips: Yes
Indicate number of shared visits/trips: 24
How often this limit applies: Every year
Are the benefits combined such that a single visit or trip limit available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?: Yes

Routine acupuncture and chiropractic

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Routine Chiropractic Care; Acupuncture Treatments
How benefits are provided: Claims Processing
Advance choice of benefits required: No
Shared limit on visits or trips: Yes
Indicate number of shared visits/trips: 20
How often this limit applies: Every year

Benefits for qualifying members

Non-Medical Transportation

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Other 5; Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning; Other 1; Other 2; Other 3; Other 4
Qualifying conditions: Chronic Hypertension
Qualifying conditions: Chronic disorders of bones, joints, and muscles
Qualifying conditions: Chronic Genitourinary Disorders
Qualifying conditions: Chronic Hyperlipidemia
Qualifying conditions: Chronic Endocrine System Disorders
Included services: Transportation for non-medical needs
Applies to out-of-network or point-of-service care: No
Some package benefits are exempt from the deductible: No

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	$42.00	$84.00	$126.00
Tier 4Non-Preferred Drug	35%	35%	35%
Tier 5Specialty Tier	31%	Not listed	Not listed

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	$43.00	$86.00	$129.00
Tier 4Non-Preferred Drug	35%	35%	35%
Tier 5Specialty Tier	31%	Not listed	Not listed

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	$42.00	$84.00	$126.00
Tier 4Non-Preferred Drug	35%	35%	35%
Tier 5Specialty Tier	31%	Not listed	Not listed

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	$43.00	$86.00	$129.00
Tier 4Non-Preferred Drug	35%	35%	35%
Tier 5Specialty Tier	31%	Not listed	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	$43.00
Tier 4Non-Preferred Drug	35%
Tier 5Specialty Tier	31%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	$43.00
Tier 4Non-Preferred Drug	35%
Tier 5Specialty Tier	31%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.