SCAN Embrace (HMO-POS I-SNP): Costs+Coverage H5425-091-0
SCAN Embrace (HMO-POS I-SNP): Costs+Coverage H5425-091-0
Discover how SCAN Embrace (HMO-POS I-SNP) stands out as a 2026 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. Dive into this detail page to see how this SCAN Health Plan 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, there are approximately 479 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 logo is a registered trademark.[2]
SCAN Embrace Overview
| Plan ID H5425-091-0 Overview | |
|---|---|
| Health Plan ID: | H5425-091-0 |
| Medicare Advantage Plan Type: | HMO-POS I-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $799.00 (In-Network) |
| Part B Give Back: | −$21.00 reduction |
| 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 Embrace (H5425-091-0) is available in the following locations (click to open):
We're Here to Help You Enroll
Health Plan Cost Sharing & Benefits
SCAN Embrace is an HMO-POS (Point-of-Service) plan. While HMO-POS plans share many features with traditional Health Maintenance Organization (HMO) plans, they offer greater flexibility by allowing members to access healthcare providers outside the network for certain services. Typically, a referral from your physician is required to go out of network. Additionally, there are separate deductibles for in-network and out-of-network services.
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 | Out-of-network: $10 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: | Not covered |
| 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: | In-network: | Tier 1 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | Tier 2 | $0 copay |
| Ground ambulance: | In-network: $95 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: $0 copay | Out-of-network: $10 copay |
| Outpatient group therapy: | In-network: $0 copay | Out-of-network: $10 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $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-$75 copay | Out-of-network: $0-$75 copay |
| Lab services: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Outpatient x-rays: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
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: $0 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: | Not covered |
| 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 |
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 (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this Special Needs Plan (H5425-091-0) 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: | $-16.40 |
| Supplemental Part D Premium: | $16.40 |
| Total Part D Premium: | $0.00 |
| Low Income Premium Subsidy: | $12.00 |
| Low Income Premium Subsidy CMS Pays: | $0.00 |
| 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 $0.00. This is the amount you must pay at the pharmacy before SCAN Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, SCAN Embrace 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 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 | 33% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage HMO-POS I-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 plan.
CMS Star Ratings for Plan H5425-091-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 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 |
Eligibility for Enrollment in SCAN Embrace
To enroll in SCAN Embrace, you must meet the following three criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You require the level of care typically provided in an institutional setting, such as a long-term care nursing facility, for 90 days or more.
This plan accomodates individuals in a long-term care facility. It is also available to people who need the level of care given in a long-term care facility who can remain at home or live in an assisted living facility.
If you live at home and need a similar level of skilled care, you may qualify for an Institutional Equivalent Special Needs Plan (IE-SNP).
Important Enrollment Periods
Once you’ve confirmed your eligibility for SCAN Embrace, 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): Your first opportunity to enroll when you become eligible for Medicare.
- Annual Enrollment Period (AEP): The time each year when you can change your Medicare plan or enroll in a new one.
- Special Enrollment Periods (SEPs): Times outside of AEP when you can make changes due to specific circumstances, such as moving to a new area or losing other insurance coverage.
To get a deeper understanding of these enrollment periods, click here to learn more and stay informed about your Medicare choices.
Contact SCAN Health Plan
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | SCAN Health Plan Plan Page |
| New Members: | 1-888-315-7226 |
| Existing Members: | 1-855-828-7226 |
| Plan Address: | 3800 Kilroy Airport Way | Suite 100 | Long Beach, CA 90806 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or 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 15, 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, "Institutional Special Needs Plans (I-SNPs)" — Last accessed September 20, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — Last accessed 5 May, 2025
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Page content managed by David Bynon, Medicare Analyst.