Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
SCAN Strive, 2027
H5425Contract097Plan
HMO C-SNP · special needs plan, chronic or disabling condition · 6 counties in California
Run by SCAN Health Plan (contract H5425), sold as SCAN Health Plan, owned by SCAN Group
SCAN Strive (H5425-097) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026).
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| In-network out-of-pocket limit | $9,250 | $9,850 | ▲up $600 |
| Drug deductible | $615 | $450 | ▼down $165 |
| Comprehensive dental, yearly limit | $4,000 a year | $3,000 a year | ▼down $1,000 |
| Eyewear, yearly limit | $350 a year | $300 a year | ▼down $50 |
| Over-the-counter items, yearly | $1,260 a year | $1,680 a year | ▲up $420 |
| Drug tier 3, preferred brand | 25% of the cost | $47 | changed |
| Drug tier 4, non-preferred drug | 30% of the cost | 25% of the cost | ▼down 5 points |
| 14 lines do not change | |||
| Monthly premium | $0 | $0 | 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 | 20% of the cost | 20% of the cost | no change |
| Medical deductible, in network | none | none | no change |
| Hospital stay, in network | not filed | not filed | no change |
| Skilled nursing facility, in network | not filed | not filed | no change |
| Ground ambulance, in network | 20% of the cost | 20% of the cost | no change |
| Hearing aids, yearly limit for both ears | not offered | not offered | no change |
| Counties served | 6 | 6 | no change |
| Drug tier 1, preferred generic | $0 | $0 | no change |
| Drug tier 2, generic | $0 | $0 | no change |
| Drug tier 5, specialty tier | 25% of the cost | 25% 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?
| Tier | What the tier holds | 2026, standard pharmacy | 2027, standard pharmacy | 2027, preferred pharmacy |
|---|---|---|---|---|
| Tier 1 | Preferred Generic | $0 | $0 | $0 |
| Tier 2 | Generic | $0 | $0 | $0 |
| Tier 3 | Preferred Brand | 25% of the cost | $47 | $42 |
| Tier 4 | Non-Preferred Drug | 30% of the cost | 25% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | 25% of the cost | 25% of the cost | 25% 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, 61 chronic or disabling condition special needs plans are sold for 2027, this one included. Against the others, 39 plans have a lower out-of-pocket limit, 21 the same. On the premium, 52 the same, 8 a higher one.
Out-of-pocket limits of the 61 chronic or disabling condition special needs plans
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 6 counties: $0 a month and $9,850.
California
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
- H5425-097
- Legal name of the contract
- SCAN Health Plan
- Sold as
- SCAN Health Plan
- Parent company
- SCAN Group
- Plan type
- HMO C-SNP
- 2026 star rating of the contract
- 4 of 5 overall; health plan 4 of 5, drug plan 4 of 5
- Members, September 2026
- 6,998
- 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 Los Angeles, 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.