SCAN Affirm partnered with Included LGBTQ+ Health (HMO) H5425-096-0 Plan Details
SCAN Affirm partnered with Included LGBTQ+ Health (HMO) H5425-096-0 Plan Details
Navigating your Medicare Advantage options for 2026 can be overwhelming, but we're here to help. With SCAN Affirm partnered with Included LGBTQ+ Health (HMO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
The latest CMS enrollment data shows an estimated 71 Medicare beneficiaries are enrolled in this plan.
SCAN Affirm partnered with Included LGBTQ+ Health Overview
| Plan ID H5425-096-0 Overview | |
|---|---|
| Health Plan ID: | H5425-096-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $500.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $250.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | SCAN Health Plan |
Plan Availability
SCAN Affirm partnered with Included LGBTQ+ Health (H5425-096-0) is available in the following locations (click to open):
Why Choose SCAN Affirm partnered with Included LGBTQ+ Health?
This Medicare Advantage Prescription Drug (MAPD) HMO plan delivers comprehensive coverage, including hospital care, medical services, and prescription drugs — all under one roof. With a monthly premium of $0.00, you’ll get the core benefits of Medicare Part A and Part B, plus drug coverage to manage ongoing prescriptions. The annual Part D deductible is $250.00. Like most HMO plans, you’ll be asked to use in-network providers unless it’s an emergency.
Primary care visits have a $0 copay, specialist visits come with a $0 copay, urgent care services carry a $0 copay, and ambulance transportation is $75 copay. These costs all apply toward the plan’s annual maximum out-of-pocket (MOOP) limit of $500.00. Once you hit that threshold, in-network services are fully covered for the rest of the year — helping you plan your healthcare spending with confidence.
CMS recognizes this plan as H5425-096-0. 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.
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Out-of-Pocket Costs
SCAN Affirm partnered with Included LGBTQ+ Health has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5425-096-0.
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) |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $0 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | In-network: $0 copay |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $90 copay |
| Wordwide emergency care: | $90 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | Tier 1 | $0 per day for days 1-3 | $50 per day for days 4-7 | $0 per day for days 8-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $50 per day for days 21-100 |
| Ground ambulance: | In-network: $75 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $20 copay |
| Outpatient group therapy: | In-network: $20 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $0 per day for days 1-3 | $50 per day for days 4-7 | $0 per day for days 8-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 copay |
| Occupational therapy: | In-network: $0 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 0%-20% coinsurance |
| Prosthetics: | In-network: 0%-20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-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) |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0-$380 copay |
| Endodontics: | In-network: $5-$395 copay |
| Restorative services: | In-network: $8-$395 copay |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0-$140 copay |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $550-$850 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by SCAN Affirm partnered with Included LGBTQ+ Health as a Part B benefit.
Part D Prescription Drug Costs & Benefits
SCAN Affirm partnered with Included LGBTQ+ Health 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 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $12.00 |
| 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 $250.00 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 Affirm partnered with Included LGBTQ+ Health may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | $42.00 copay | Coming soon |
| Non-Preferred Drug | 35% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 Affirm partnered with Included LGBTQ+ Health?
You are eligible to enroll in SCAN Affirm partnered with Included LGBTQ+ Health 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 Affirm partnered with Included LGBTQ+ Health and take advantage of its full range of benefits.
When Can I Enroll in SCAN Affirm partnered with Included LGBTQ+ Health?
Understanding the right time to enroll in SCAN Affirm partnered with Included LGBTQ+ Health is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
How to Sign Up for SCAN Affirm partnered with Included LGBTQ+ Health
Joining SCAN Affirm partnered with Included LGBTQ+ Health 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 Affirm partnered with Included LGBTQ+ Health.
- Direct Enrollment: You can also choose to enroll directly with SCAN Affirm partnered with Included LGBTQ+ Health. 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 H5425-096-0:
What’s the monthly premium for SCAN Affirm partnered with Included LGBTQ+ Health (HMO)?
The 2026 premium is $0.00 each month, and you must continue to pay your Part B premium.
What’s the MOOP for SCAN Affirm partnered with Included LGBTQ+ Health in 2026?
Your costs top out at $500.00 (for in-network services) in 2026; after that the plan pays 100% of covered services.
How much do I pay before drug coverage starts?
The 2026 drug deductible is $250.00.
How is this plan rated by Medicare?
The latest CMS score is ★4.0 out of 5 stars; anything 4 or higher earns quality bonuses.
How many members does SCAN Affirm partnered with Included LGBTQ+ Health have?
As of last month, about 71 beneficiaries are enrolled.
Contact SCAN Health Plan
| Contact Type | Details |
|---|---|
| Website: | SCAN Health Plan Plan Page |
| New Members: | 1-888-315-7226 |
| Existing Members: | 1-800-559-3500 |
| Plan Address: | 3800 Kilroy Airport Way | Suite 100 | Long Beach, CA 90806 |
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.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- SCAN Health Plan, http://www.scanhealthplan.com — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — Last accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options" — Last accessed 25 May, 2025
Medicare.org is owned and operated by Health Network Group, LLC, an Allstate company. Medicare.org provides information only and is not connected with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content managed by David Bynon, Medicare Analyst.
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