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$370
Max OOP in network$299
Max OOP out of network$0
Initial coverage limit$2,400
Catastrophic limit$2,400
Availability
Available in Orange County, CAOrange County, CA
Available Cities
This plan is available in 28+ cities in California.
Aliso Viejo
Orange County
Anaheim
Orange County
Buena Park
Orange County
Capistrano Beach
Orange County
Cerritos
Orange County
Corona Del Mar
Orange County
Costa Mesa
Orange County
Coto De Caza
Orange County
Cowan Heights
Orange County
Cypress
Orange County
Foothill Ranch
Orange County
Fountain Valley
Orange County
Huntington Beach
Orange County
La Habra Heights
Orange County
Laguna Hills
Orange County
Laguna Niguel
Orange County
Lake Forest
Orange County
Midway City
Orange County
Mission Viejo
Orange County
Newport Beach
Orange County
Rancho Santa Margarita
Orange County
Rossmoor
Orange County
San Clemente
Orange County
Santa Ana
Orange County
Santa Ana Height
Orange County
Seal Beach
Orange County
Stanton
Orange County
Westminster
Orange County
Benefits
Primary care
In Network
In-Network: $0 copay per visit
Inpatient hospital
In Network
In-Network: $0 copay per admission.
Skilled nursing
In Network
In-Network: $0 copay per day for days 1-20, $50 copay per day for days 21-100.
Emergency care
In Network
In-Network: $115 copay per visit
Urgently needed care
In Network
In-Network: $0 copay for Medicare-covered urgently-needed-care visits.
Ambulance
In Network
In-Network: $100 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 IDH5425-141-000
Plan number141
ContractH5425
Segment0
DRX ID0JL84TZNT0
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