SCAN DaVita Dialysis Care (HMO-POS C-SNP) H5943-005 • 2027 • Riverside County, CA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $2950.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $370.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Riverside County, CA
- Local Enrollment
- 0 beneficiaries in Riverside County
Introduction
SCAN DaVita Dialysis Care is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by VillageHealth. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $0.00 monthly premium, $0.00 medical deductible, and $2950.00 in-network maximum out-of-pocket. CMS Plan ID H5943-005 identifies this plan. The 2027 Part D prescription drug deductible is $370.00.
You must live in Riverside County, California to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Riverside County. For assistance with this plan, new members can call (877)916-1234 (TTY (888)722-6889).
Eligibility
SCAN DaVita Dialysis Care is a Medicare C-SNP plan for individuals with specific chronic conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with chronic kidney disease and/or post-renal organ transplantation.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Riverside County
Compare this plan with the two most-enrolled HMO-POS C-SNP plans available in Riverside County, California. Enrollment is based on CMS local enrollment data.
| Plan Detail | SCAN DaVita Dialysis Care | UHC Complete Care CA-20P | SCAN DaVita Dialysis Care Complete |
|---|---|---|---|
| CMS Plan ID | H5943-005-0 |
H0543-219-0 |
H5943-003-0 |
| Local Enrollment | 0 | 2,477 | 283 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $2,950.00 | $999.00 | $9,850.00 |
| Part B Giveback | Not offered | −$6.00 reduction | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $0 copay | $0 copay | $0 copay |
| Part D Deductible | $370.00 | $595.00 | $175.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | Not covered | $0 copay | Not covered |
Plan Benefits
SCAN DaVita Dialysis Care has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5943-005.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5943-005-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Specialist
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $150 copay
Out-of-network: $150 copay - Lab services
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Outpatient x-rays
- In-network: $20 copay
Out-of-network: $20 copay - Diagnostic tests and procedures
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $150 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $30 copay
- Inpatient hospital care
- In-network:
Tier 1
$300 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$300 per day for days 1-6
$7 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$200 per day for days 21-100 - Ground ambulance
- In-network: $300 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Outpatient group therapy
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$300 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
$300 per day for days 1-6
$7 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Occupational therapy
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance - Durable medical equipment
- In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance - Prosthetics
- In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: 25% coinsurance
- Endodontics
- In-network: 25% coinsurance
- Restorative services
- In-network: 25% coinsurance
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 25% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- Not covered
- Fitting/evaluation
- Not covered
- Prescription hearing aids
- Not covered
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by SCAN DaVita Dialysis Care as a Part B benefit.
Prescription Drug Coverage
SCAN DaVita Dialysis Care includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $370.00 annual Part D deductible. You'll pay this deductible at the pharmacy before VillageHealth starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, SCAN DaVita Dialysis Care may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Not available |
| Generic | $0.00 copay | Not available |
| Preferred Brand | $42.00 copay | Not available |
| Non-Preferred Drug | 35% coinsurance | Not available |
| Specialty Tier | 29% coinsurance | Not available |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5943)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | Not enough data available |
| Complaints and Changes in Plans Performance | Not enough data available |
| Health Plan Customer Service | Not enough data available |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Not enough data available |
| Member Experience with the Drug Plan | Not enough data available |
| Drug Safety and Accuracy of Drug Pricing | Not enough data available |
Contact Information for VillageHealth
- Website
- VillageHealth Plan Page
- Providers
- VillageHealth Providers Page
- Formulary
- VillageHealth Formulary Page
- Pharmacy
- VillageHealth Pharmacy Page
- New Member Health Plan Help
- (877)916-1234
- New Member Health Plan TTY
- (888)722-6889
- New Member Part D Help
- (877)916-1234
- New Member Part D TTY Users
- (888)722-6889
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| VillageHealth (official source) | http://www.villagehealthca.com | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | April 28, 2026 |
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