SCAN Strive (HMO C-SNP): Costs+Coverage H5244-004-0
SCAN Strive (HMO C-SNP): Costs+Coverage H5244-004-0
Uncover the tailored benefits and costs of SCAN Strive (HMO C-SNP), a 2025 Medicare Special Needs Plan crafted to support your specific healthcare requirements. Dive into this detail page to see how this SCAN Health Plan New Mexico SNP can support your specific health conditions or financial circumstances.
This private health insurance option offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
According to CMS enrollment data (May, 2025), there are approximately 0 members enrolled in this plan.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The SCAN Health Plan New Mexico logo is a registered trademark.[2]
SCAN Strive Overview
| Plan ID H5244-004-0 Overview | |
|---|---|
| Health Plan ID: | H5244-004-0 |
| Medicare Advantage Plan Type: | HMO C-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $15.80 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $9,350.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $590.00 deductible |
| Additional Benefits: | Vision |
| Availability: | See List |
| Insured By: | SCAN Health Plan New Mexico |
We're Here to Help You Enroll
Health Plan Cost Sharing & Benefits
SCAN Strive is a Health Maintenance Organization (HMO) plan. As an HMO member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, SCAN Strive does cover out-of-network care for emergencies and out-of-area dialysis.
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: | 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 |
|---|---|
| Emergency room care: | 20% Coinsurance |
| Urgent care: | 20% Coinsurance |
| Ground ambulance: | 20% Coinsurance |
| 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) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | 20% Coinsurance |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | 20% Coinsurance Prior Authorization Required, Referral Required |
| 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) |
|---|---|
| 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) |
|---|---|
| Physical therapy and speech and language therapy: | 20% Coinsurance Prior Authorization Required, Referral Required |
| Occupational therapy: | 20% Coinsurance Prior Authorization Required, Referral Required |
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: | Not Covered |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 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: | 20% Coinsurance Prior Authorization Required, Referral Required |
| Lab services: | Not Covered |
| Outpatient x-rays: | 20% Coinsurance Prior Authorization Required, Referral Required |
| Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required, Referral Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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) |
|---|---|
| Medicare Covered Preventive Dental | 20% Coinsurance |
| 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) |
|---|---|
| Fitting/evaluation | Not Covered |
| Hearing aids | Not Covered |
| Hearing exam | Not Covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | 20% Coinsurance |
| 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: | $300.00 Every year |
Do you have questions about the costs in this plan? Call 1-833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this Special Needs Plan (H5244-004-0) and other plans on this site.
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $15.80 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $15.80 |
| Low Income Premium Subsidy: | $15.83 |
| Low Income Premium Subsidy CMS Pays: | $15.80 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before SCAN Health Plan New Mexico begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, SCAN Strive has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $0.00 |
| Generic* | $0.00 | $0.00 |
| Preferred Brand | 24.00% | 25.00% |
| Non-Preferred Drug | 45.00% | 45.00% |
| Specialty Tier | 25.00% | 25.00% |
| *Deductible does not apply. | ||
CMS Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage HMO C-SNPs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this SCAN Health Plan New Mexico plan.
CMS Star Ratings for Plan H5244-004-0 – 2025
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Eligibility Criteria for Enrolling in SCAN Strive
To enroll in SCAN Strive , you must meet the following criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You have been diagnosed with one or more severe or disabling chronic conditions.
This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes.
SNP Plan Enrollment Periods
Once you’ve confirmed your eligibility for SCAN Strive , it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
To get a deeper understanding of these enrollment periods, click here to learn more and stay informed about your Medicare choices.
Plan Availability
SCAN Strive (H5244-004-0) is available in the following locations (click to open):
Contact SCAN Health Plan New Mexico
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | SCAN Health Plan New Mexico Plan Page |
| Providers: | SCAN Health Plan New Mexico Providers Page |
| Formulary: | SCAN Health Plan New Mexico Formulary Page |
| Pharmacy: | SCAN Health Plan New Mexico Pharmacy Page |
| New Member Health Plan Help: | (844)716-4424 |
| New Member Health Plan TTY: | (888)722-6889 |
| New Member Part D Help: | (844)716-4424 |
| New Member Part D TTY Users: | (888)722-6889 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.
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SCAN Health Plan New Mexico Official Plan Details – 2025
Official webpage by SCAN Health Plan New Mexico detailing the Aetna Medicare Preferred (HMO D-SNP) plan benefits, coverage, and enrollment options.
Source Webpage: https://www.scanhealthplan.com -
CMS Medicare Advantage and Prescription Drug Plan Landscape Files – 2025
Official CMS dataset detailing Medicare Advantage and Prescription Drug plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: cy2025-landscape-202412.zip
Source Webpage: CMS Medicare Coverage: Prescription Drug Coverage -
CMS Medicare Star Ratings Data Tables – 2025
Official CMS Star Ratings dataset providing performance ratings for Medicare plans for 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: 2025-star-ratings-data-tables.zip
Source Webpage: CMS Part C and D Performance Data -
CMS Plan Benefits Package (PBP) Files – 2025
Official CMS dataset providing detailed plan benefit information for Medicare Advantage plans in 2025.
Creator: Centers for Medicare & Medicaid Services
Data Format: ZIP Archive
Coverage Period: January 1, 2025 – December 31, 2025
Download: pbp-benefits-2025.zip
Source Webpage: CMS Medicare Advantage and Part D Benefits Data