SCAN DaVita Dialysis Care Complete (HMO-POS C-SNP)

SCAN DESERT HEALTH PLAN, INC. · 2027 plan year

Plan ID H1822-011-000

HMOPOS★ 3.5 CMS StarsChronic or Disabling Condition SNPNew for 2027
MOOP (in-network)
$9,850
MOOP (combined)
$9,850
Monthly premium
$12/mo
Part C $0 + Part D $12, before Extra Help
Prescription drugs
Included

Plan information

Contract / Plan / Segment
H1822-011-000
Medical deductible
Medicare Part B deductible (CMS has not yet announced the 2027 amount)
Part D premium
$12/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
Part D deductible
$450/yr
Also owed
Your Medicare Part B premium, paid separately

More SCAN DESERT HEALTH PLAN, INC. plans in AZ

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — AcuteOriginal Medicare cost sharing
Inpatient Hospital — PsychiatricOriginal Medicare cost sharing

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual SessionsNo charge
Supplemental Health BenefitsSee plan details
Mental Health — Group SessionsNo charge

Other

BenefitIn-network
Prosthetics & OrthoticsSee plan details
Diabetic Supplies & ServicesSee plan details
Diabetic Therapeutic Shoes & InsertsNo charge
Diabetic Monitors0%-20% coinsurance
Dialysis Services20% coinsurance
Medicare-Covered Preventive ServicesSee plan details
Fitness BenefitNo charge
Dental — Endodontics (Root Canal)No charge
Dental — Removable Prosthodontics (Dentures)No charge
Vision — Routine Eye ExamsNo charge
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass LensesNo charge
Vision — Eyeglass FramesNo charge
Hearing — Exams20% coinsurance
Intensive Outpatient Program (IOP)No charge
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Physician Specialist ServicesNo charge
Other Health Care Professional ServicesNo charge
Psychiatric ServicesSee plan details
Air Ambulance20% coinsurance
Durable Medical Equipment (DME)0%-20% coinsurance
Prosthetic Devices0%-20% coinsurance
Medical Supplies0%-20% coinsurance
Diabetic Supplies0%-20% coinsurance
Annual Physical ExamNo charge
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Dental — Other Preventive ServicesNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative ServicesNo charge
Dental — Periodontics (Gum Care)No charge
Dental — Fixed Prosthodontics (Bridges)No charge
Dental — Oral & Maxillofacial SurgeryNo charge
Dental — Adjunctive General ServicesNo charge
Vision — Eye Exams20% coinsurance
Vision — Eye ExamsSee plan details
Vision — Eyewear20% coinsurance
Vision — EyewearSee plan details
Chiropractic Services20% coinsurance
Occupational Therapy ServicesNo charge
Podiatry Services20% coinsurance
Psychiatric Services — Individual SessionsNo charge
Psychiatric Services — Group SessionsNo charge
Physical Therapy & Speech-Language PathologyNo charge
Ground Ambulance20% coinsurance
Ambulance ServicesSee plan details
Skilled Nursing Facility (SNF)Original Medicare cost sharing
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional Sessions20% coinsurance
Intensive Cardiac Rehabilitation — Additional Sessions20% coinsurance
Pulmonary Rehabilitation — Additional Sessions20% coinsurance
Supervised Exercise Therapy (SET)20% coinsurance
Emergency Services20% coinsurance (max $110)
Urgently Needed Services20% coinsurance (max $40)
Partial Hospitalization ProgramNo charge
Additional Telehealth Services (Part B)No charge
Opioid Treatment Program Services20% coinsurance
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests20% coinsurance
Laboratory ServicesNo charge
Radiological ServicesSee plan details
Diagnostic Radiology20% coinsurance
Therapeutic Radiology20% coinsurance
X-Ray Services20% coinsurance
Outpatient Hospital Services20% coinsurance
Hospital Observation Services20% coinsurance
Ambulatory Surgical Center (ASC)20% coinsurance
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions20% coinsurance
Substance Abuse — Group Sessions20% coinsurance
Outpatient Blood ServicesNo charge
Remote Access TechnologiesNo charge
Personal Emergency Response System (PERS)No charge
In-Home Support ServicesNo charge
Caregiver Support ServicesNo charge
Kidney Disease Education Services20% coinsurance
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)0%-20% coinsurance (max $35)
Dental — Medicare-Covered Services20% coinsurance

Service area

  • AZ: 2 counties

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