Dear Tom and Alan:
What is the deal with SCAN? I see ads in the paper for it, but I don’t know anyone who’s on it.
Is it available everywhere? How much does it cost? Should I dump my very expensive Medicare Supplement plan and get on it?
My health plan and my drug plan keep going up and up.
Tom: SCAN is fairly new to our area. The Senior Care Action Network (SCAN) actually began in 1977. It is a Medicare Advantage Plan and an HMO (Health Maintenance Organization).
There is only one other Advantage plan in Napa County and that’s Kaiser Senior Advantage. The SCAN Classic, available in Napa and Sonoma counties, is similar to Kaiser in that subscribers choose a primary care physician and all patient care and referrals go through the primary care physician.
We now have about 10 local doctors who are contracted with SCAN as well as a number of specialists.
Al: This is very important because when SCAN began in Napa a few years ago, we had zero doctors.
Tom: Correct. Also, the really appealing part of SCAN is that there is zero premium. Many people are skeptical about a medical plan that includes prescription drugs and costs them nothing each month.
Al: Sounds Un-American. How does that work?
Tom: The federal government pays SCAN a certain amount each month to take on patients. Of course, the individual does have copays for services when he/she uses them.
For example, inpatient hospital charges are $195 per day for the first five days; outpatient surgery is listed at $100 to $225; doctor visits are $5 for the primary care physician and $15 for specialists. There are also copayments for drugs.
Al: SCAN also offers two dental plans for $8 and $16 per month respectively. They are quite proud of their 4.5-star rating for 2016. This compares with Kaiser’s five-star rating.
SCAN is contracted with Queen of the Valley Hospital and Santa Rosa Memorial, among others (not St. Helena).
Tom: Now, as to our reader’s question about dumping his/her expensive Medicare Supplement plan…
Al: My default answer is always, “If you can afford it, keep it because it is essentially 100 percent medical coverage.”
Since any doctor in the United States who accepts Medicare will also take our reader’s plan, it offers a lot of flexibility.
On the other hand, in the worst-case scenario, a subscriber could be on the hook for $3,400 if he reached the “maximum out of pocket” for the SCAN plan.
Tom: We’ve had several Medicare Advantage Plans in Napa that have come and gone: Pacificare, Humana, and Anthem Blue Cross.
I’m not saying SCAN is going to leave, but others have. In any case, “Curious” will have to wait because the next open enrollment period for Advantage plans is Oct. 15 to Dec. 7 later this year. Meanwhile, those turning 65 can apply right away.