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1-on-1 Medicare for Californians

San Fernando Valley, California

MAPD 2027 plan HMO

SCAN Classic (HMO)

Plan information effective January 1, 2027.

SCAN Health Plan Plan ID H5425-128-000 Plan #128 MAPD

Plan costs & ratings

Monthly premium$0.00
Annual premium$0.00
Medical premium$0.00
Medical deductible$0
Drug premium$0.00
Drug deductible$450
Medical out-of-pocket limit (in network)$2,900
Part D annual out-of-pocket threshold$2,400

Availability

Available in 4 California counties

Placer County, CA, Sacramento County, CA, San Joaquin County, CA, Yolo County, CA

Available Cities

This plan is available in 33+ cities in California.

Benefits

Primary care In Network

In-Network: $0 copay per visit

Inpatient hospital In Network

In-Network: $99 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, $125 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: $150 copay per trip

Dental In Network

In-Network: $0 copay for Medicare-covered Dental Services

Vision In Network

This plan includes: Eye Exams, Eyewear.

Hearing In Network

In-Network: $0 copay for Medicare-covered Hearing Services

Over-the-counter In Network

In-Network: $0 copay; Maximum plan benefit coverage of $75.00 every 3 month.

Transportation In Network

In-Network: $0 copay; Limit of 18 visits every year.

Fitness In Network

In-Network: $0 copay for Fitness Benefit.

Notes

Drug deductible details: $0 Deductible on Tier(s) 1, 2; $450 Deductible on Tier(s) 3, 4, 5

Plan Overview

CarrierSCAN Health Plan
OrganizationSCAN HEALTH PLAN
Plan typeMAPD
PlanHMO
Drug coverageIncluded
Enrollment hours8 am to 8 pm
Carrier websiteOpen website

Plan identifiers

Plan IDH5425-128-000
Plan number128
ContractH5425
Segment0
DRX ID1B4W226BY0
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