Medicare Plans

Open Medicare Plan Data.

SCAN Balance Texas (HMO C-SNP) Medicare Special Need Plan H8902-002 • 2027

CMS Rating: Not yet rated by CMS.
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$2000.00In-network
Part B Giveback
Not offered
Prescription Coverage
Enhanced, $450.00 deductible
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
1,177 beneficiaries
Last update:

Introduction

SCAN Balance Texas is a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by SCAN Health Plan. The plan uses a Health Maintenance Organization (HMO) 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 $2000.00 in-network maximum out-of-pocket. CMS Plan ID H8902-002 identifies this plan. The 2027 Part D prescription drug deductible is $450.00.

CMS reports 1,177 beneficiaries enrolled across all service areas. You must live in the plan's service area to enroll: See List.

Eligibility

SCAN Balance Texas is a Medicare C-SNP plan for individuals with specific chronic or disabling 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 cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
Service Area Requirement
Must live in the plan's service area
Prescription Drug Coverage
Medicare Part D prescription drug coverage is included.

Plan Benefits

SCAN Balance Texas 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 H8902-002.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay In-network: $0 copay
Specialist In-network: $0-$15 copay In-network: $0-$15 copay

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 In-network: $0 copay
Telehealth benefit In-network: $0-$15 copay In-network: $0-$20 copay
Routine chiropractic In-network: $5 copay In-network: $5 copay
Fitness benefits Coming soon In-network: $0 copay
Health education In-network: $0 copay In-network: $0 copay
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay In-network: $0 copay
Health transportation (non-emergency) Coming soon In-network: $0 copay

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$125 copay In-network: $0-$125 copay
Lab services In-network: $0 copay In-network: $0 copay
Outpatient x-rays In-network: $0 copay In-network: $0 copay
Diagnostic tests and procedures In-network: $30 copay In-network: $30 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $115 copay $90 copay
Worldwide emergency care Coming soon $90 copay
Urgent care $20 copay $20 copay
Inpatient hospital care Tier 1
$125 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$95 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Skilled Nursing Facility Tier 1
$0 per day for days 1-20
$221 per day for days 21-100		 Tier 1
$0 per day for days 1-20
$140 per day for days 21-100
Ground ambulance In-network: $225 copay In-network: $225 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $15 copay In-network: $15 copay
Outpatient group therapy In-network: $15 copay In-network: $15 copay
Inpatient psychiatric hospital care Tier 1
$125 per day for days 1-5
$0 per day for days 6-90
$0 per stay		 Tier 1
$95 per day for days 1-5
$0 per day for days 6-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $15 copay In-network: $15 copay
Occupational therapy In-network: $15 copay In-network: $15 copay

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 In-network: $0 copay
Durable medical equipment In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance
Prosthetics In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

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 In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance In-network: 0%-20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay In-network: $0 copay
Dental x-rays In-network: $0 copay In-network: $0 copay
Cleaning In-network: $0 copay In-network: $0 copay
Periodontics In-network: 25% coinsurance In-network: $0 copay
Endodontics In-network: 25% coinsurance In-network: $0 copay
Restorative services In-network: 25% coinsurance In-network: $0 copay
Implant services Not covered In-network: $0 copay
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: 25% coinsurance In-network: $0 copay

Vision Services

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

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay In-network: $0 copay
Fitting/evaluation In-network: $0 copay In-network: $0 copay
Prescription hearing aids In-network: $550-$950 copay In-network: $550-$850 copay
OTC hearing aids Not covered Not covered

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 Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon In-network: $0 copay
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by SCAN Balance Texas as a Part B benefit.

Prescription Drug Coverage

SCAN Balance Texas 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.

SCAN Balance Texas (H8902-002-0) Prescription Drug Plan Premium Details
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:$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 $450.00 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, SCAN Balance Texas may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

SCAN Balance Texas (H8902-002-0) Pharmacy Out-of-Pocket Costs by Drug Tier
Drug Tier Retail Mail Order
Preferred Generic$0.00 copay$0.00 copay
Generic$0.00 copay$0.00 copay
Preferred Brand$42.00 copay$42.00 copay
Non-Preferred Drug35% coinsurance35% coinsurance
Specialty Tier28% coinsurance33% coinsurance
*Deductible does not apply.

CMS 5-Star Performance Ratings (Contract ID: H8902)

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.

2027 Medicare Star Ratings for Contract H8902
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines Not enough data available
Managing Chronic (Long Term) Conditions Not enough data available
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 ☆☆☆☆☆

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
(855)601-7223
New Member Health Plan TTY
(888)722-6889
New Member Part D Help
(855)601-7223
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
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 Chronic Condition Special Needs Plans (C-SNPs) April 28, 2026
CMS.gov Medicare Advantage Plan Fact Sheet April 28, 2026
Medicare.gov Joining a plan April 28, 2026

MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.