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$399
Max OOP out of network$0
Initial coverage limit$2,400
Catastrophic limit$2,400
Availability
Available in San Bernardino County, CASan Bernardino County, CA
Available Cities
This plan is available in 41+ cities in California.
Adelanto
San Bernardino County
Alta Loma
San Bernardino County
Angelus Oaks
San Bernardino County
Apple Valley
San Bernardino County
Arrowbear Lake
San Bernardino County
Barstow
San Bernardino County
Big Bear City
San Bernardino County
Big Bear Lake
San Bernardino County
Bloomington
San Bernardino County
Bryn Mawr
San Bernardino County
Chino
San Bernardino County
Chino Hills
San Bernardino County
Crestline
San Bernardino County
Daggett
San Bernardino County
East Highland
San Bernardino County
Essex
San Bernardino County
Etiwanda
San Bernardino County
Fontana
San Bernardino County
Grand Terrace
San Bernardino County
Helendale
San Bernardino County
Hesperia
San Bernardino County
Joshua Tree
San Bernardino County
Lake Arrowhead
San Bernardino County
Landers
San Bernardino County
Loma Linda
San Bernardino County
Lucerne Valley
San Bernardino County
Mentone
San Bernardino County
Montclair
San Bernardino County
Muscoy
San Bernardino County
Ontario
San Bernardino County
Phelan
San Bernardino County
Pinon Hills
San Bernardino County
Rancho Cucamonga
San Bernardino County
Redlands
San Bernardino County
Rialto
San Bernardino County
San Bernardino
San Bernardino County
Spring Valley La
San Bernardino County
Twentynine Palms
San Bernardino County
Upland
San Bernardino County
Yucaipa
San Bernardino County
Yucca Valley
San Bernardino 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: $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: $200 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 IDH5425-144-000
Plan number144
ContractH5425
Segment0
DRX ID1JZRT1Z1NR
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