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$999
Max OOP out of network$0
Initial coverage limit$2,400
Catastrophic limit$2,400
Availability
Available in 2 California countiesSanta Clara County, CA, Stanislaus County, CA
Available Cities
This plan is available in 22+ cities in California.
Campbell
Santa Clara County
Gilroy
Santa Clara County
Los Altos
Santa Clara County
Los Gatos
Santa Clara County
Milpitas
Santa Clara County
Monte Vista
Santa Clara County
Morgan Hill
Santa Clara County
Mountain View
Santa Clara County
Palo Alto
Santa Clara County
San Jose
Santa Clara County
Santa Clara
Santa Clara County
Saratoga
Santa Clara County
Stanford
Santa Clara County
Sunnyvale
Santa Clara County
Ceres
Stanislaus County
Denair
Stanislaus County
Modesto
Stanislaus County
Patterson
Stanislaus County
Riverbank
Stanislaus County
Salida
Stanislaus County
Turlock
Stanislaus County
Waterford
Stanislaus 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, $221 copay per day for days 21-100.
Emergency care
In Network
In-Network: $125 copay per visit
Urgently needed care
In Network
In-Network: $0 copay for Medicare-covered urgently-needed-care visits.
Ambulance
In Network
In-Network: $95 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 IDH5425-137-000
Plan number137
ContractH5425
Segment0
DRX ID1N12TNPRRT
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