Page 42 - Appendices for Eric Hartman
P. 42
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This is your current plan's benefit
summary for the 2023 plan year.
SCAN Health Plan
SCAN Venture (HMO)
Plan type: Medicare Advantage with drug coverage
Plan ID: H5425-084-0
Plan website Non-members: 1-888-315-7226 Members: 1-800-559-3500
What you'll pay
Total monthly Health Primary 2023 estimated total drug costs (lowest cost retail
premium deductible doctor pharmacy)
$0.00 $0.00 $0 $0.00
copay Covers 4 of 4 drugs
Overview
PREMIUMS
Total monthly premium $0.00
Health premium $0.00
Drug premium $0.00
Standard Part B premium $164.90
In Orange County, Part B
premium is reduced by $110 a
Part B premium reduction Yes page (see next page from plan's
Evidence of Coverage)
