
SCAN Classic (HMO) H5425-007-0 Plan Details
SCAN Classic (HMO) H5425-007-0 Plan Details
Choosing the right Medicare Advantage plan is crucial for your healthcare needs in 2025. With SCAN Classic (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data (May, 2025), there are approximately 39,561 members enrolled in this plan.
SCAN Classic Overview
Plan ID H5425-007-0 Overview | |
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Health Plan ID: | H5425-007-0 |
Medicare Advantage Plan Type: | HMO |
Plan Year: | 2025 |
Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $199.00 (In-Network) |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
Additional Benefits: | Dental, Vision, Hearing |
Availability: | See List |
Insured By: | SCAN Health Plan |
Plan Availability
SCAN Classic (H5425-007-0) is available in the following locations (click to open):
Explore the Benefits of SCAN Classic
SCAN Classic is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that combines hospital, medical, and drug coverage into one streamlined option. With a monthly premium of $0.00, it includes all benefits under Medicare Part A and Part B, along with built-in prescription drug coverage. The annual Part D deductible is $0.00. You’ll typically need to use doctors and providers in the plan’s network, except for emergency situations.
Primary care visits have a not covered, specialist visits come with a not covered, urgent care services carry a not covered, and ambulance transportation is $100 copay. These costs all apply toward the plan’s maximum out-of-pocket (MOOP) limit of $199.00 . Once that limit is met, all in-network healthcare services are fully covered for the rest of the year. That’s a major plus for those who want both medical and drug coverage bundled into one predictable package.
This plan is listed by CMS as H5425-007-0. You’ll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
We're Here to Help You Enroll |
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Out-of-Pocket Expenses
With SCAN Classic , you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H5425-007-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
Service | Enrollee Cost (in-network) |
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Primary: | Not Covered |
Specialist: | Not Covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
Service | Enrollee Cost |
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Emergency room care: | $90 Copay |
Urgent care: | Not Covered |
Ground ambulance: | $100 Copay |
Inpatient hospital care: | |
Skilled Nursing Facility: |
This section covers Medicare-approved foot care services, including exams and routine foot care.
Service | Enrollee Cost (in-network) |
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Foot Exams and Treatments (Medicare-covered): | Not Covered |
Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
Service | Enrollee Cost (in-network) |
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Medicare-covered chiropractic: | Not Covered |
Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
Service | Enrollee Cost (in-network) |
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Outpatient individual therapy: | Not Covered |
Outpatient group therapy: | Not Covered |
Inpatient psychiatric hospital care: |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
Service | Enrollee Cost (in-network) |
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Physical therapy and speech and language therapy: | Not Covered |
Occupational therapy: | Not Covered |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
Service | Enrollee Cost (in-network) |
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Diabetes supplies: | Not Covered |
Durable medical equipment: | Not Covered |
Prosthetics: | Not Covered |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
Service | Enrollee Cost (in-network) |
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Diagnostic radiology services: | Not Covered |
Lab services: | Not Covered |
Outpatient x-rays: | Not Covered |
Diagnostic tests and procedures: | Not Covered |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
Service | Enrollee Cost (in-network) |
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Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
Service | Member Cost (in-network) |
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Medicare Covered Preventive Dental | Not Covered |
Oral exam | |
Dental x-rays | |
Cleaning | |
Periodontics | |
Endodontics | |
Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
Service | Member Cost (in-network) |
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Fitting/evaluation | Covered Limits may apply |
Hearing aids | Covered Limits may apply |
Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
Service | Member Cost (in-network) |
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Medicare-covered eye exam (in-network) | |
Routine eye exam (in-network) | Covered Limits may apply |
Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $250.00 Every year |
Certain preventive services are covered 100% by SCAN Classic as a Part B benefit.
Part D Prescription Drug Costs & Benefits
SCAN Classic includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
Basic Part D Premium: | $0.00 |
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Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $0.00 |
Low-Income Premium Subsidy: | ${part_d_lips_amount} |
Low-Income Premium Subsidy Paid by CMS: | $0.00 |
Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before SCAN Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, SCAN Classic may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
Drug Tier | Retail | Mail Order |
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Preferred Generic | $0.00 | $7.00 |
Generic | $0.00 | $15.00 |
Preferred Brand | $42.00 | $47.00 |
Non-Preferred Drug | 50.00% | 50.00% |
Specialty Tier | 33.00% | 33.00% |
*Deductible does not apply. |
How CMS Star Ratings Guide Your Choice
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
CMS Measure | Star Rating |
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2025 Overall 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in SCAN Classic ?
You are eligible to enroll in SCAN Classic if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for SCAN Classic and take advantage of its full range of benefits.
When Can I Enroll in SCAN Classic ?
Knowing when you can enroll in SCAN Classic is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Sign Up for SCAN Classic
Joining SCAN Classic is straightforward. Here are the steps you can take:
- Online: Use our online enrollment partner's Secure Online Enrollment Form to sign up.
- By Phone: Reach out to HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will help you with the enrollment process and answer any questions you might have.
- Through Medicare.gov: Enroll directly through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the steps to join SCAN Classic .
- Direct Enrollment: You can also choose to enroll directly with SCAN Classic . The contact information can be found below in the "Contact" section.
Make sure you enroll during the appropriate period to activate your coverage as soon as possible.
Here are some of the most frequently asked questions people have about plan ID H5425-007-0:
Is there a premium for this plan in 2025?
Members pay their Part B premium and the plan's of $0.00 per month to be in this 2025 plan.
How high can my costs go in a worst-case year?
The annual in-network MOOP is $199.00 , protecting you from larger bills once you hit that limit.
What’s the prescription-drug deductible for 2025?
Yes. The Part D deductible is $0.00. The plan does not have a drug tier without a deductible.
How is this plan rated by Medicare?
CMS rates it ★4.5 out of 5 stars for 2025.
How many members does SCAN Classic have?
CMS reports 39,561 members in the latest file.
Contact SCAN Health Plan
Website: | SCAN Health Plan Plan Page |
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Providers: | SCAN Health Plan Providers Page |
Formulary: | SCAN Health Plan Formulary Page |
Pharmacy: | SCAN Health Plan Pharmacy Page |
New Member Health Plan Help: | (888)315-7226 |
New Member Health Plan TTY: | (888)722-6889 |
New Member Part D Help: | (888)315-7226 |
New Member Part D TTY Users: | (888)722-6889 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- SCAN Health Plan, http://www.scanhealthplan.com, Last Accessed June 1, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans", Last Accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You", Last Accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
Medicare Advantage and Part D plans and benefits offered by: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.