Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

SCAN Prime, 2027

H5425Contract065Plan

HMO · 3 counties in California

Run by SCAN Health Plan (contract H5425), sold as SCAN Health Plan, owned by SCAN Group

Renews for 2027

2026 star rating, contract H5425: 4 of 5

SCAN Prime (H5425-065) costs $20 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $2,499.

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
Drug deductible	$250	$370	up $120
Skilled nursing facility, in network	$0 a stay	$0 a day for days 1–20, then $221 a day for days 21–100	up $2,210for a 30-day stay
Eyewear, yearly limit	$200 a year	$125 a year	down $75
Over-the-counter items, yearly	$200 a year	$100 a year	down $100
Drug tier 5, specialty tier	30% of the cost	29% of the cost	down 1 point
16 lines do not change
Monthly premium	$20	$20	no change
In-network out-of-pocket limit	$2,499	$2,499	no change
Part B premium reduction, monthly	none	none	no change
Primary care visit	$0 copay	$0 copay	no change
Specialist visit	$0 copay	$0 copay	no change
Emergency room	$120 copay	$120 copay	no change
Medical deductible, in network	none	none	no change
Hospital stay, in network	$100 a day for days 1–3, then $0 a day for days 4–90	$100 a day for days 1–3, then $0 a day for days 4–90	no change
Ground ambulance, in network	$200 copay	$200 copay	no change
Comprehensive dental, yearly limit	$4,000 a year	$4,000 a year	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Counties served	3	3	no change
Drug tier 1, preferred generic	$5	$5	no change
Drug tier 2, generic	$12	$12	no change
Drug tier 3, preferred brand	$47	$47	no change
Drug tier 4, non-preferred drug	35% of the cost	35% of the cost	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked. The plan charges less at its preferred pharmacies
Tier	What the tier holds	2026, standard pharmacy	2027, standard pharmacy	2027, preferred pharmacy
Tier 1	Preferred Generic	$5	$5	$0
Tier 2	Generic	$12	$12	$0
Tier 3	Preferred Brand	$47	$47	$42
Tier 4	Non-Preferred Drug	35% of the cost	35% of the cost	35% of the cost
Tier 5	Specialty Tier	30% of the cost	29% of the cost	29% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 106 plans open to everyone are sold for 2027, this one included. Against the others, 71 plans have a lower out-of-pocket limit, 2 the same, 32 a higher one. On the premium, 96 plans have a lower premium, 9 a higher one.

Out-of-pocket limits of the 106 plans open to everyone

$0 to under $2,00066 plans

$2,000 to under $4,000 (this plan)23 plans

$4,000 to under $6,00011 plans

$6,000 to under $8,0005 plans

$8,000 to $10,0001 plan

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 3 counties: $20 a month and $2,499.

California

Los Angeles Orange San Bernardino

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H5425-065
Legal name of the contract: SCAN Health Plan
Sold as: SCAN Health Plan
Parent company: SCAN Group
Plan type: HMO
2026 star rating of the contract: 4 of 5 overall; health plan 4 of 5, drug plan 4 of 5
Members, September 2026: 3,450
Plan website, as filed with CMS: www.scanhealthplan.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Orange, CAWhere most of its members live; premiums and limits side by side
Every SCAN Health Plan plan for 2027Its contracts, counties and plans that end
The other 61 plans of contract H5425Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.