MAPD
2027 plan HMO 3
SCAN Balance (HMO C-SNP)
Plan information effective January 1, 2027.
Plan costs & ratings
Monthly premium$27.00
Medical premium$27.00
Drug premium$0.00
Annual premium$324.00
Medical deductible$0
Drug deductible$450
Max OOP in network$4,200
Max OOP out of network$0
Initial coverage limit$2,400
Catastrophic limit$2,400
Availability
Available in Sonoma County, CASonoma County, CA
Available Cities
This plan is available in 7+ cities in California.
Benefits
Primary care
In Network
In-Network: $0 copay per visit
Inpatient hospital
In Network
In-Network: $250 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, $200 copay per day for days 21-100.
Emergency care
In Network
In-Network: $130 copay per visit
Urgently needed care
In Network
In-Network: $0 copay for Medicare-covered urgently-needed-care visits.
Ambulance
In Network
In-Network: $150 copay per trip
Plan Overview
CarrierSCAN Health Plan
OrganizationSCAN HEALTH PLAN
Plan typeMAPD
PlanHMO
SNP type3
Drug coverageIncluded
Enrollment hours8 am to 8 pm
Provider searchOpen provider directory
Carrier websiteOpen website
Plan identifiers
Plan IDH5425-150-000
Plan number150
ContractH5425
Segment0
DRX ID1TRMC7KZYN
Carrier ID15
Formulary ID27384
Formulary versionV11 Last Updated 09-01-2026
Carrier contact
Carrier phone8778704867
Enrollment phone8778704867
Enrollment TTY711
Carrier hours8 am to 8 pm
Network & documents
Preferred pharmacy networkYes
Preferred retail pharmacyYes
Preferred mail pharmacyYes
Mail drug benefitsYes
Provider searchYes
Chronic Care