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Springs Advantage, a SCAN Medicare Plan (HMO-POS I-SNP) Medicare Special Need Plan H3879-001 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$55.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$4000.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $200.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
0 beneficiaries
Last update:

Introduction

CMS Plan ID H3879-001 identifies Springs Advantage, a SCAN Medicare Plan, a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by SCAN Health Plan. Its provider network is a Health Maintenance Organization with a Point of Service (HMO-POS), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $55.00 monthly premium, $0.00 medical deductible, and $4000.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $200.00.

Enrollment across the plan's service areas totals 0 beneficiaries, according to CMS. Enrollment is limited to beneficiaries who live within the plan's service area: See List.

Eligibility

Springs Advantage, a SCAN Medicare Plan is a Hybrid Institutional (HI-SNP) plan for individuals that require nursing care.

Special Needs Plan Type
Institutional Special Needs Plan (I-SNP)
Medicare Requirement
Must have Medicare Part A and Part B
Special Needs Requirement
This plan accommodates individuals in a long-term care facility. It is also available to people who need the level of care given in a long-term care facility who can remain at home or live in an assisted living facility.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Plan Benefits

Springs Advantage, a SCAN Medicare Plan 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 H3879-001.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay Coming soon
Specialist In-network: $10 copay
Out-of-network: $10 copay		 Coming soon

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay Coming soon
Telehealth benefit In-network: $0-$10 copay Coming soon
Routine chiropractic In-network: $10 copay Coming soon
Fitness benefits Coming soon Coming soon
Health education In-network: $0 copay Coming soon
Counseling services Not covered Coming soon
Over-the-counter drug benefits In-network: $0 copay Coming soon
Health transportation (non-emergency) Coming soon Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$75 copay
Out-of-network: $0-$75 copay		 Coming soon
Lab services In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Outpatient x-rays In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon
Diagnostic tests and procedures In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance		 Coming soon

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $90 copay Coming soon
Worldwide emergency care Coming soon Coming soon
Urgent care $0 copay Coming soon
Inpatient hospital care In-network:
Tier 1
$250 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Coming soon
Skilled Nursing Facility In-network:
$0 copay		 Coming soon
Ground ambulance In-network: $95 copay Coming soon

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $10 copay
Out-of-network: $10 copay		 Coming soon
Outpatient group therapy In-network: $10 copay
Out-of-network: $10 copay		 Coming soon
Inpatient psychiatric hospital care In-network:
Tier 1
$250 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Coming soon

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $10 copay Coming soon
Occupational therapy In-network: $10 copay Coming soon

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: 0%-20% coinsurance Coming soon
Durable medical equipment In-network: 0%-20% coinsurance Coming soon
Prosthetics In-network: 0%-20% coinsurance Coming soon

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance Coming soon
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance Coming soon

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay Coming soon
Dental x-rays In-network: $0 copay Coming soon
Cleaning In-network: $0 copay Coming soon
Periodontics In-network: $0 copay Coming soon
Endodontics In-network: $0 copay Coming soon
Restorative services In-network: $0 copay Coming soon
Implant services Not covered Coming soon
Orthodontics Not covered Coming soon
Oral/Maxillofacial surgery In-network: $0 copay Coming soon

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay Coming soon
Contact lenses In-network: $0 copay Coming soon
Eyeglass frames only In-network: $0 copay Coming soon
Eyeglass lenses only In-network: $0 copay Coming soon
Eyeglasses (frames & lenses) In-network: $0 copay Coming soon
Upgrades Not covered Coming soon

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay Coming soon
Fitting/evaluation In-network: $0 copay Coming soon
Prescription hearing aids In-network: $0 copay Coming soon
OTC hearing aids Not covered Coming soon

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Coming soon
Home-based palliative care Not covered Coming soon
Personal emergency response system Coming soon Coming soon
Weight management programs Not covered Coming soon
Wigs for chemotherapy-related hair loss Coming soon Coming soon
Alternative therapies Not covered Coming soon
Massage therapy Not covered Coming soon
Home/bathroom safety devices Not covered Coming soon

Certain preventive services are covered 100% by Springs Advantage, a SCAN Medicare Plan as a Part B benefit.

Prescription Drug Coverage

Springs Advantage, a SCAN Medicare Plan 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.

Springs Advantage, a SCAN Medicare Plan (H3879-001-0) Prescription Drug Plan Premium Details
Part D Premium Component Amount
Basic Part D Premium:($22.10)
Supplemental Part D Premium:$22.10
Total Part D Premium:$0.00
Low-Income Premium Subsidy:$6.27
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 $200.00 annual Part D deductible. You'll pay this deductible at the pharmacy before SCAN Health Plan starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, Springs Advantage, a SCAN Medicare Plan may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Springs Advantage, a SCAN Medicare Plan (H3879-001-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copayNot available
Generic$0.00 copayNot available
Preferred Brand$42.00 copayNot available
Non-Preferred Drug35% coinsuranceNot available
Specialty Tier31% coinsuranceNot available
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H3879)

Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.

2027 Medicare Star Ratings for Contract H3879
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines {hd1}
Managing Chronic (Long Term) Conditions {hd2}
Member Experience with Health Plan {hd3}
Complaints and Changes in Plans Performance {hd4}
Health Plan Customer Service {hd5}
Drug Plan Customer Service {dd1}
Complaints and Changes in the Drug Plan {dd2}
Member Experience with the Drug Plan {dd3}
Drug Safety and Accuracy of Drug Pricing {dd4}

Contact Information for SCAN Health Plan

Website
SCAN Health Plan Plan Page
Providers
SCAN Health Plan Providers Page
Formulary
SCAN Health Plan Formulary Page
Pharmacy
SCAN Health Plan Pharmacy Page
New Member Health Plan Help
(833)945-7226
New Member Health Plan TTY
(888)722-6889
New Member Part D Help
(833)945-7226
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.

Plan Availability

Springs Advantage, a SCAN Medicare Plan (H3879-001-0) is available in the following locations (click to open):

Clackamas
Washington
Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
SCAN Health Plan (official source) http://www.scanhealthplan.com October 4, 2026
CMS.gov Institutional Special Needs Plans (I-SNPs) April 28, 2026
Medicare.gov Understanding Medicare Advantage Plans April 28, 2026
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You April 28, 2026

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Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.