2023 SCAN Venture (HMO)
SCAN Venture (HMO) H5425-084 is a 2023 Medicare Advantage Plan or Part-C by SCAN Health Plan available to residents in California. 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 $1,000 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $1,000 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 California.
Ready to Enroll?
Mon-Fri 8am-11pm EST
2023 SCAN Health Plan Medicare Advantage Plan Overview
|Name:||SCAN Venture (HMO)|
|Plan ID:||H5425 084 0|
|Provider:||SCAN Health Plan|
|Combined Premium (C+D):||$0/mo|
|Part C Premium:||$0/mo|
|Part D (Drug) Premium:||$0/mo|
|Part D Supplemental Premium||$0/mo|
|Total Part D Premium:||$0/mo|
|Tiers with No Deductible:||0|
|Benchmark:||Not below the regional benchmark|
|Type of Medicare Health:||Enhanced Alternative|
|Drug Benefit Type:||Enhanced|
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?
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.
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 $1,000. Once you spend $1,000 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.
The complete SCAN Venture (HMO) Formulary.
*Initial Coverage Phase and 30 day supply
CMS Star Ratings
Is SCAN Venture (HMO) a good plan? SCAN Venture (HMO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare SCAN Venture (HMO) performance among several different plans.
|2022 Overall Rating|
|Part C Summary Rating|
|Part-D Summary Rating|
|Staying Healthy: Screenings, Tests, Vaccines|
|Managing Chronic (Long Term) Conditions|
|Member Experience with Health Plan|
|Complaints and Changes in Plans Performance|
|Health Plan Customer Service|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Staying Healthy, Screening, Testing, & Vaccines
|Total Preventative Rating|
|Breast Cancer Screening|
|Colorectal Cancer Screening|
|Annual Flu Vaccine|
|Monitoring Physical Activity|
Managing Chronic And Long Term Care for Older Adults
|SNP Care Management|
|Diabetes Care - Eye Exam|
|Diabetes Care - Kidney Disease|
|Diabetes Care - Blood Sugar|
|Controlling Blood Pressure|
|Reducing Risk of Falling|
|Improving Bladder Control|
Member Experience with H5425-084 Health Plan
|Total Experience Rating|
|Getting Needed Care|
|Health Care Quality|
|Rating of Health Plan|
Member Complaints and Changes in Plans Performance
|Complaints about Health Plan|
|Members Leaving the Plan|
|Health Plan Quality Improvement|
Health Plan Customer Service Rating for SCAN Health Plan
|Total Customer Service Rating|
|Timely Decisions About Appeals|
|Reviewing Appeals Decisions|
|Call Center, TTY, Foreign Language|
Drug Plan Customer Service Ratings
|Call Center, TTY, Foreign Language|
Ratings For Member Complaints and Changes in the Drug Plans Performance
|Complaints about the Drug Plan|
|Members Choosing to Leave the Plan|
|Drug Plan Quality Improvement|
Member Experience with the Drug Plan
|Rating of Drug Plan|
|Getting Needed Prescription Drugs|
Drug Safety and Accuracy of Drug Pricing
|MPF Price Accuracy|
|Drug Adherence for Diabetes Medications|
|Drug Adherence for Hypertension (RAS antagonists)|
|Drug Adherence for Cholesterol (Statins)|
|MTM Program Completion Rate for CMR|
|Statin with Diabetes|
Ready to Enroll?
Mon-Sun 8am-11pm EST
(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:
Go to top
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 $1,000. Once you spend $1,000 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).
Is SCAN Venture (HMO) a good plan?
SCAN Venture (HMO) received a 4.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.
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.