2023 SCAN Venture (HMO)

SCAN Venture (HMO) H0978-004 is a 2023 Medicare Advantage Plan or Part-C by SCAN Health Plan available to residents in Nevada. This plan includes additional prescription drug (Part-D) coverage. SCAN Health Plan SCAN Venture (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $1,800 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $1,800 out-of-pocket. This can be an extremely nice safety net.

SCAN Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for SCAN Venture (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from SCAN Health Plan and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from SCAN Health Plan except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Nevada.




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2023 SCAN Health Plan Medicare Advantage Plan Overview

Name:SCAN Venture (HMO)
Plan ID:H0978 004 0
Provider:SCAN Health Plan
Year:2023
Type:Local HMO
Combined Premium (C+D):$0/mo
Part C Premium:$0/mo
MOOP:$1,800/yr
Part D (Drug) Premium:$0/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$0/mo
Drug Deductible:$0/yr
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:Not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H0978-005




What type of plan is SCAN Venture (HMO)

SCAN Venture (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.



How much does SCAN Venture (HMO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. SCAN Health Plan charges a $0 consolidated premium. The Part C premium is $0 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. SCAN Venture (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This SCAN Health Plan plan offers a $0 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by SCAN Health Plan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $0. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


SCAN Health Plan Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This SCAN Health Plan plan does offer additional coverage through the gap.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. SCAN Venture (HMO) by SCAN Health Plan MOOP is $1,800. Once you spend $1,800 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.



Formulary and Drug Coverage

SCAN Venture (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $0 $10
Tier 2 $0 $20
Tier 3 $40 $47
Tier 4 $95 $100
Tier 5 33% 33%

The complete SCAN Venture (HMO) Formulary.
*Initial Coverage Phase and 30 day supply





2023 Summary of Benefits


The benefit information provided is a summary of what SCAN Venture (HMO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from SCAN Health Plan helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)Covered



Contact lenses


Vision$0 copay



Eyeglass frames


Vision$0 copay



Eyeglass lenses


Vision$0 copay



Eyeglasses (frames and lenses)


Vision$0 copay



Other


VisionNot covered



Routine eye exam


Vision$0 copay



Upgrades


VisionNot covered




Transportation$0 copay
Skilled Nursing Facility$0 per day for days 1 through 20
$175 per day for days 21 through 100



Occupational therapy visit


Rehabilitation services$0-5 copay



Physical therapy and speech and language therapy visit


Rehabilitation services$0-5 copay



Cleaning


Preventive dental$0 copay



Dental x-ray(s)


Preventive dental$0 copay



Fluoride treatment


Preventive dentalNot covered



Oral exam


Preventive dental$0 copay




Preventive care$0 copay
Outpatient hospital coverage$5-275 copay per visit
In-Network Other health plan deductibles?No
Optional supplemental benefitsNo



Inpatient hospital - psychiatric


Mental health services$200 per day for days 1 through 7
$0 per day for days 8 through 90



Outpatient group therapy visit


Mental health services$0-30 copay



Outpatient group therapy visit with a psychiatrist


Mental health services$0-30 copay



Outpatient individual therapy visit


Mental health services$0-30 copay



Outpatient individual therapy visit with a psychiatrist


Mental health services$0-30 copay



Chemotherapy


Medicare Part B drugs20% coinsurance



Other Part B drugs


Medicare Part B drugs20% coinsurance



Diabetes supplies


Medical equipment/supplies$0 copay



Durable medical equipment (e.g., wheelchairs, oxygen)


Medical equipment/supplies0-20% coinsurance per item



Prosthetics (e.g., braces, artificial limbs)


Medical equipment/supplies0-20% coinsurance per item




Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$1,800 In-network
Inpatient hospital coverage$150 per day for days 1 through 6
$0 per day for days 7 through 90



Fitting/evaluation


Hearing$0 copay



Hearing aids


Hearing$450-750 copay



Hearing exam


Hearing$5 copay




Health plan deductible$0
Ground ambulance$250 copay



Foot exams and treatment


Foot care (podiatry services)$0-5 copay



Routine foot care


Foot care (podiatry services)$0 copay



Emergency


Emergency care/Urgent care$90 copay per visit (always covered)



Urgent care


Emergency care/Urgent care$10 copay per visit (always covered)



Primary


Doctor visits$0 copay



Specialist


Doctor visits$0-5 copay per visit



Diagnostic radiology services (e.g., MRI)


Diagnostic procedures/lab services/imaging$0-25 copay



Diagnostic tests and procedures


Diagnostic procedures/lab services/imaging$0 copay



Lab services


Diagnostic procedures/lab services/imaging$0 copay



Outpatient x-rays


Diagnostic procedures/lab services/imaging$0 copay



Diagnostic services


Comprehensive dental$0-5 copay



Endodontics


Comprehensive dental$5-395 copay



Extractions


Comprehensive dental$0-140 copay



Non-routine services


Comprehensive dental$0-125 copay



Periodontics


Comprehensive dental$0-380 copay



Prosthodontics, other oral/maxillofacial surgery, other services


Comprehensive dental$13-395 copay



Restorative services


Comprehensive dental$8-395 copay




In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?No





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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for SCAN Venture (HMO) requires you to live in that plan’s service area. The service area is listed below:



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How much does SCAN Venture (HMO) cost?

SCAN Health Plan charges a $0 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is SCAN Venture (HMO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. SCAN Venture (HMO) by SCAN Health Plan MOOP is $1,800. Once you spend $1,800 you will pay nothing for Part A or Part B covered services.

What type of plan is SCAN Venture (HMO)?

SCAN Venture (HMO) is a Local HMO. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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