Scan is a regional Medicare Advantage plan, not a national one, so whether it's a good fit depends on where you live and what coverage matters most to you

Scan Health Plan operates in California, Arizona, Nevada, and New Mexico. It is one of many Medicare Advantage options available in those states, and it has both strengths and limitations that are worth understanding before you decide. The plan is run by Scan Group, a nonprofit organization that has been in the Medicare Advantage business since 1977.

Whether Scan is right for you is not a yes-or-no question. It depends on your doctors, your prescriptions, your budget, and what kind of coverage you need. This guide walks you through what to look for when comparing Scan to other plans in your area.

Key Takeaways

  • Scan is available only in California, Arizona, Nevada, and New Mexico, so you can only choose it if you live in one of those states.
  • Like all Medicare Advantage plans, Scan includes hospital, doctor, and prescription drug coverage in one plan, but the specific doctors and drugs covered vary by plan type and location.
  • You should check whether your current doctors are in Scan's network before you enroll, because using an out-of-network doctor usually costs you more.
  • Scan offers different plan types (HMO, PPO, and PFFS) with different rules about referrals and out-of-network care, so the right choice depends on how you use healthcare.
  • The best way to compare Scan to other plans is to use Medicare.gov's plan comparison tool during open enrollment, entering your doctors and medications to see actual costs.

What Scan Health Plan Covers

Scan includes hospital care, doctor visits, and prescription drugs in one monthly premium. You do not pay a separate Part B premium to Medicare if you are enrolled in Scan (though you still pay Part B to stay covered). Depending on which Scan plan you choose, you may also have dental, vision, or hearing coverage included.

The specific coverage and costs depend on which Scan plan you pick. Scan offers HMO plans (which require you to use in-network doctors and usually require referrals), PPO plans (which let you see out-of-network doctors for a higher cost), and PFFS plans (Private Fee-for-Service, which work differently from HMOs). Each type has different copays, deductibles, and out-of-pocket limits.

You can see the full list of Scan plans available in your county on Medicare.gov. The site shows the monthly premium, deductible, copays for specific services, and the maximum you could pay out of pocket in a year.

How to Check If Your Doctors Are In-Network

This is the single most important step before you enroll. If your doctor is not in Scan's network, you will either pay more to see them or have to switch doctors. Many people find out too late that their doctor is out of network, and then they have to change plans during the next open enrollment.

Go to Medicare.gov and use the plan comparison tool. Enter your zip code, the Scan plan you are considering, and your doctor's name. The tool will tell you whether that doctor is in the network. If your doctor is not listed, call Scan directly at the phone number on the plan's details page and ask whether they participate.

Do this for every doctor you see regularly — your primary care doctor, any specialists, and any urgent care or imaging centers you use. If even one important doctor is out of network and you do not want to switch, Scan may not be the right plan for you.

Prescription Drug Coverage and Formulary

Scan includes prescription drug coverage, but not every drug is covered at the same price. Each Scan plan has a formulary — a list of covered drugs organized by tier. Tier 1 drugs are usually the cheapest, and higher tiers cost more. Some drugs may not be on the formulary at all, which means Scan does not cover them.

If you take regular medications, check Scan's formulary before you enroll. Go to Medicare.gov, find the Scan plan you are considering, and look for the formulary link. Search for each of your medications and note which tier they are on. Then compare the copay amounts across plans.

If a drug you need is not on the formulary, you can ask Scan for an exception, but there is no may provide they will approve it. If you have a medication that is not covered and you cannot get an exception, you may need to choose a different plan.

HMO, PPO, and PFFS Plans: What the Differences Mean

Scan offers three different types of Medicare Advantage plans, and they work very differently. An HMO (Health Maintenance Organization) requires you to use doctors in Scan's network and usually requires a referral from your primary care doctor before you see a specialist. Out-of-network care is usually not covered except in emergencies. HMOs typically have lower premiums and copays.

A PPO (Preferred Provider Organization) lets you see any doctor without a referral, but you pay less if you use in-network doctors. Out-of-network doctors are covered, but at a higher copay. PPOs usually have higher premiums than HMOs but give you more flexibility.

A PFFS (Private Fee-for-Service) plan works differently from both. You can see any doctor who agrees to accept the plan's payment terms, and you do not need referrals. However, not all doctors participate in PFFS plans, so you should check before you enroll. PFFS plans are less common and may have different rules about out-of-pocket costs.

If you have a doctor who is not in Scan's network but you want to stay with them, a PPO plan gives you that option — though you will pay more. If you want the lowest cost and do not mind using only in-network doctors, an HMO may be better.

What to Compare When Looking at Scan Against Other Plans

Do not choose a plan based on the monthly premium alone. Two plans with the same premium can cost you very different amounts depending on how often you go to the doctor and which medications you take.

Use the Medicare.gov plan comparison tool to see the total estimated cost for a year, including premiums, copays, and deductibles. Enter your doctors and medications so the tool can calculate what you would actually pay. Compare at least three plans — Scan and two others available in your area.

Pay attention to the out-of-pocket maximum. This is the most you will pay in a year for covered services. Once you hit this number, the plan covers the rest. Plans with lower premiums sometimes have higher out-of-pocket maximums, so the total cost can be similar.

Also check whether the plan covers services you use. If you go to physical therapy, get hearing aids, or use mental health services, make sure those are covered and at what cost. Some Scan plans include these; others do not.

When to Enroll in Scan and How to Switch Plans

You can enroll in Scan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Changes take effect on January 1. If you are new to Medicare, you have a seven-month window to enroll without penalty.

If you are already in a different Medicare Advantage plan and want to switch to Scan, you can do so during the Annual Enrollment Period. You can also switch if you move out of your current plan's service area or if you lose your plan for other reasons.

To enroll, go to Medicare.gov, call 1-800-MEDICARE, or contact Scan directly. You will need your Medicare number, which is on your Medicare card.

Frequently Asked Questions

Can I use Scan if I live outside California, Arizona, Nevada, or New Mexico?

No. Scan only operates in those four states. If you move to a state where Scan does not operate, you will need to choose a different Medicare Advantage plan. You can switch plans without penalty if you move.

Does Scan cover out-of-network doctors?

It depends on the plan type. HMO plans do not cover out-of-network care except emergencies. PPO plans cover out-of-network doctors but at a higher copay. Check the specific plan details to see what you would pay.

What if my doctor is not in Scan's network?

You have two options: switch to a different plan that includes your doctor, or switch doctors. You can also ask Scan whether your doctor participates, since the online directory is not always up to date. If your doctor is essential to your care, choosing a different plan may be better.

Can I switch from Scan to Original Medicare?

Yes. You can switch during the Annual Enrollment Period or during the Medicare Advantage Open Enrollment Period (January 1 to March 31). If you switch to Original Medicare, you may want to enroll in a Medigap or Part D plan to cover costs that Original Medicare does not.

How do I know if Scan is cheaper than other plans?

Use the Medicare.gov plan comparison tool and enter your doctors, medications, and zip code. The tool shows estimated yearly costs for each plan. Compare at least three plans to see which one costs the least for your specific situation.