SCAN Health Plan Offers Tips on What Seniors Should Look for in Pharmacy Benefits When Choosing a Medicare Advantage Plan

Date Posted: 11/03/2015

(LONG BEACH, Calif.) — Between now and December 7, Medicare-eligible individuals will be making important decisions regarding their healthcare coverage for 2016, weighing benefit options, provider networks and cost. Among the most important consideration for seniors is pharmacy coverage, where benefits and copays also vary between health plans.

“Most Medicare Advantage plans feature all of the basic benefits traditionally covered under Medicare as well as a prescription drug benefit (Medicare Part D), but out-of-pocket drug costs can vary quite a bit among health plans,” said Cathy Batteer, general manager at the not-for-profit SCAN Health Plan. “When evaluating plans it is important to take a good look at pharmacy coverage and be prepared to ask the right questions.”

Batteer recommends that consumers ask these three questions when comparing pharmacy benefits:

  • Are my drugs covered? Most plans list the drugs they cover on a formulary, which can be found on the health plan’s website and on the Medicare website at “When considering a plan, be sure to look up any maintenance drugs you currently take to see if they are covered and at what cost,” said Batteer. She says SCAN ensures it provides coverage for safe and effective medications its members use most.
  • What are the copays? Copayments can vary widely not just from plan to plan, but also from county to county. Most plans provide complete benefit information on their website and on the Medicare website at
  • Are there discounts to make maintenance medication more affordable? For 2016 many of the SCAN plans (Classic, Balance, Heart First and Signature Plans) will feature a dramatic savings opportunity on prescription drugs. While copayments vary by county, these members will be able to get a three-month supply (90 days) of Tier 1 and Tier 2 drugs and only pay for two months. “Many seniors take several medications to help them manage chronic, long-term conditions; and we don’t want the cost of these drugs to be a barrier to good health,” said Batteer.

“We understand that the annual enrollment period can be a confusing time given all of the choices and changes that take place from year to year,” added Batteer. “SCAN is committed to providing stable, dependable benefits plans – and keeping copayments as low as possible – so our members can better budget for their healthcare costs.”

The annual enrollment period for selecting a Medicare Advantage plan for 2016 runs from October 15 to December 7, 2015. During this time seniors and others on Medicare may choose to switch their health plan or move from traditional Medicare to a Medicare Advantage plan (or move back to Original Medicare) with their new elections taking effect January 1, 2016.

In 2016 the SCAN Classic plan will be available to Medicare-eligible beneficiaries in 12 California counties: Los Angeles, Marin, Napa, Orange, Riverside, San Bernardino, San Diego, San Francisco, San Joaquin, Santa Clara, Sonoma and Ventura. SCAN has earned a 4.5-star rating* in all 12 California counties it serves.

SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage plans. Further information may be obtained at or on Facebook at

As governed by the Centers for Medicare & Medicaid Services, member benefits vary by county. Specific information on SCAN’s 2016 benefit plans is available at or by calling 1-855-561-7226, 8 a.m. to 8 p.m., seven days a week. TTY/TDD users may call 711.

SCAN Health Plan is an HMO plan with a Medicare contract. Enrollment in SCAN Health Plan depends on contract renewal.

* 4.5-star rating applies to all plans offered by SCAN Health Plan (HMO) in California except Healthy At Home (HMO SNP) and VillageHealth (HMO SNP/HMO POS-SNP). Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.

You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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Ross Goldberg
818-597-8453, x-1