MAPD
2027 plan HMO
SCAN Costco Medicare Advantage (HMO)
Plan information effective January 1, 2027.
Plan costs & ratings
Monthly premium$0.00
Medical premium$0.00
Drug premium$0.00
Annual premium$0.00
Medical deductible$0
Drug deductible$450
Max OOP in network$2,000
Max OOP out of network$0
Initial coverage limit$2,400
Catastrophic limit$2,400
Availability
Available in 2 California countiesAlameda County, CA, San Mateo County, CA
Available Cities
This plan is available in 33+ cities in California.
Alameda
Alameda County
Albany
Alameda County
Berkeley
Alameda County
Castro Valley
Alameda County
Dublin
Alameda County
Fremont
Alameda County
Hayward
Alameda County
Kensington
Alameda County
Livermore
Alameda County
Newark
Alameda County
Oakland
Alameda County
Piedmont
Alameda County
Pleasanton
Alameda County
San Leandro
Alameda County
San Lorenzo
Alameda County
Union City
Alameda County
Atherton
San Mateo County
Belmont
San Mateo County
Daly City
San Mateo County
East Palo Alto
San Mateo County
Foster City
San Mateo County
Half Moon Bay
San Mateo County
Hillsborough
San Mateo County
Montara
San Mateo County
Pacifica
San Mateo County
Redwood City
San Mateo County
San Bruno
San Mateo County
San Carlos
San Mateo County
San Gregorio
San Mateo County
San Mateo
San Mateo County
South San Franci
San Mateo County
West Menlo Park
San Mateo County
Woodside
San Mateo County
Benefits
Primary care
In Network
In-Network: $0 copay per visit
Inpatient hospital
In Network
In-Network: $195 copay per day for days 1-5, $0 copay per day for days 6-90.
Skilled nursing
In Network
In-Network: $0 copay per day for days 1-20, $100 copay per day for days 21-100.
Emergency care
In Network
In-Network: $120 copay per visit
Urgently needed care
In Network
In-Network: $0 copay for Medicare-covered urgently-needed-care visits.
Ambulance
In Network
In-Network: $180 copay per trip
Plan Overview
CarrierSCAN Health Plan
OrganizationSCAN HEALTH PLAN
Plan typeMAPD
PlanHMO
Drug coverageIncluded
Enrollment hours8 am to 8 pm
Provider searchOpen provider directory
Carrier websiteOpen website
Plan identifiers
Plan IDH5425-139-000
Plan number139
ContractH5425
Segment0
DRX ID1BJPSK8DRC
Carrier ID15
Formulary ID27384
Formulary versionV11 Last Updated 09-01-2026
Carrier contact
Carrier phone8336089576
Enrollment phone8336089576
Enrollment TTY711
Carrier hours8 am to 8 pm
Network & documents
Preferred pharmacy networkYes
Preferred retail pharmacyYes
Preferred mail pharmacyYes
Mail drug benefitsYes
Provider searchYes