Understanding Scan Health Plans: What They Are and How They Work

Scan Health Plan is a Medicare Advantage organization that provides health insurance coverage to people who are eligible for Medicare. The company operates in several states, primarily in California, Nevada, Arizona, and Kansas. Understanding what Scan offers is the first step in learning about whether their plan options might meet your health care needs.

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A Medicare Advantage plan, also known as a Part C plan, is an alternative way to receive your Medicare benefits. Instead of getting coverage through Original Medicare (Part A and Part B), you can choose to receive your benefits through a private insurance company like Scan. These plans must cover all the services that Original Medicare covers, but they do many things differently. They often include prescription drug coverage (Part D) built into the plan, and they may offer additional benefits that Original Medicare does not provide.

Scan Health Plan was founded in 1997 and has grown to serve over 200,000 members. The company focuses on Medicare Advantage plans and Special Needs Plans (SNPs). SNPs are designed for people with specific chronic conditions or who live in certain institutions. By learning about how Scan structures its plans, you can better understand whether their offerings might fit your situation.

Medicare Advantage plans use networks of doctors, hospitals, and specialists. This means that to receive covered services at the lowest cost, you generally need to use providers within the plan's network. Some plans may allow you to see out-of-network providers, but this typically costs more. Scan Health Plans operate using this network model, which affects how you choose and pay for care.

Practical Takeaway: Before diving into specific plan details, recognize that Scan Health Plans are one option among many Medicare Advantage providers. Learning about how these plans structure coverage, networks, and costs will help you understand what questions to ask and what information to gather about your own health care needs.

Plan Types and Coverage Options Available Through Scan

Scan Health Plan offers several types of plans, each designed for different situations and health needs. The main categories include Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Special Needs Plans. Each type has different rules about how you access care and what you pay.

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HMO plans require you to choose a primary care doctor who coordinates your care. To see a specialist, you typically need a referral from your primary care doctor first. HMO plans have lower monthly premiums compared to some other plan types, and your out-of-pocket costs may be lower when you use in-network providers. However, HMO plans are generally more restrictive about which doctors and hospitals you can use. If you go out of network without authorization, you may have to pay the full cost yourself, except in emergencies.

PPO plans offer more flexibility than HMO plans. You can see any doctor or specialist without a referral, and you can go out of network if you choose. However, you will pay more for out-of-network care. PPO plans typically have higher monthly premiums than HMO plans, and your deductibles may be higher as well. PPO plans work well for people who want maximum flexibility and don't mind paying more for that freedom.

Special Needs Plans (SNPs) are designed for people in specific situations. These include people with certain chronic illnesses like diabetes, heart disease, or chronic obstructive pulmonary disease (COPD). Scan also offers SNPs for people who are dually eligible for both Medicare and Medicaid, and for people who live in long-term care facilities. SNPs often provide more targeted services related to your specific condition.

Each plan type includes prescription drug coverage. Scan's drug formularies (the list of covered medications) vary by plan and region. The formulary determines which medications are covered and at what cost. Some medications may require prior authorization, which means your doctor must get approval from the plan before the medication is covered.

Practical Takeaway: When learning about Scan's plan options, first identify which type of plan structure appeals to you—HMO if you prefer lower costs and don't mind restrictions, or PPO if you want more flexibility. Then, investigate whether Scan offers plans in your state and whether any special needs plans match your health situation.

Costs Associated with Scan Health Plans

Understanding the costs of a health plan is crucial because premiums are only one part of what you will pay. Scan Health Plans, like all Medicare Advantage plans, have several types of costs you need to consider: monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums.

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The monthly premium is the amount you pay to the insurance company each month to have coverage. Many Scan plans have a $0 premium, meaning you pay nothing extra each month beyond what you already pay for Medicare Part B. Some Scan plans do charge a monthly premium, which can range from a few dollars to several hundred dollars depending on the plan and your location. You must continue paying your Medicare Part B premium regardless of which plan you choose.

A deductible is the amount of money you must pay out of your own pocket before the plan starts paying for services. Some Scan plans have no deductible for certain services like primary care visits, while other plans do have deductibles. Deductibles typically reset each calendar year on January 1st.

Copayments are fixed dollar amounts you pay for specific services. For example, a plan might charge a $15 copay for a primary care visit, a $50 copay for an emergency room visit, or a $250 copay for an inpatient hospital stay. Copayments do not count toward your out-of-pocket maximum in most Medicare Advantage plans, though this varies.

Coinsurance is when you pay a percentage of the cost of a service rather than a fixed amount. For example, you might pay 20% of the cost of a specialist visit. Coinsurance amounts do typically count toward your out-of-pocket maximum.

The out-of-pocket maximum is the most you will have to pay in a calendar year for covered services. Once you reach this amount, the plan pays 100% of covered services for the rest of the year. For 2024, the out-of-pocket maximum for Medicare Advantage plans is capped at $7,550 for in-network services.

Practical Takeaway: Compare plans not just by premium, but by looking at the complete cost picture. Calculate how much you would pay annually based on how often you visit doctors, what medications you take, and what services you expect to use. A plan with a higher premium might actually cost you less overall if you have low copayments and deductibles.

Network Providers and How to Find Doctors Within Scan Plans

One of the most important features of any Scan Health Plan is its provider network. The network consists of doctors, hospitals, specialists, and other health care providers who have agreed to provide services to plan members. Using in-network providers is important because it affects what you pay and what services are covered.

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Scan maintains different networks in different states and regions. In California, where Scan has the largest presence, the network is extensive and includes many major hospitals and medical groups. The network is smaller in other states where Scan operates. Before choosing a Scan plan, you should verify that the doctors you currently see are in the plan's network, or that there are other in-network options available in your area.

To find providers in a Scan network, you can use the Scan website's provider directory tool. This tool allows you to search for doctors by specialty, location, and name. You can also call Scan's customer service line to ask about specific providers. It's important to verify that a provider is currently accepting new patients, as the directory information is updated regularly but may not always reflect the most current status.

Primary care doctors play a special role in HMO plans. If you choose an HMO, you will need to select a primary care physician from the network when you enroll. This doctor will be responsible for coordinating your care and providing referrals to specialists. Changing your primary care doctor is possible, but it requires notifying the plan, typically by calling customer service or making changes during the annual enrollment period.

Specialists, hospitals, and urgent care facilities are also part of the network. For HMO plans, you typically need a referral from your primary care doctor before seeing a specialist. PPO plans usually allow you to see specialists without a referral. You can see out