Medicare Plan Lookup Official CMS data · Contract Year 2027
CMS 2027 data

2027 Medicare plan code

H5943-005

Medicare Plan

SCAN DaVita Dialysis Care (HMO-POS C-SNP) · VillageHealth · HMOPOS · Orange, Riverside, and San Bernardino counties

Full CMS plan ID: H5943-005-000

H5943-005-000 is the full CMS identifier for the H5943-005 Medicare plan. Common searches include H5943 005 and H5943005.

2027

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2027 plan record

SCAN DaVita Dialysis Care (HMO-POS C-SNP)

H5943-005-000 Orange, Riverside, and San Bernardino counties HMOPOS Chronic or Disabling Condition

At-a-glance

Quick view

01

In-network

Inpatient hospital

Days 1–6 $300 / day
Days 7–90 $0 / day
Total of listed copays · 6 charged days $1,800
Out-of-network

Not separately reported

Point of service

Tier 1: $300 / day for days 1–6; $7 / day for days 7–90; $0 per stay

02

Emergency transport

Ambulance

Ground · in-network$300 copay
Air · in-network$300 copay
03

Emergency services

Emergency room

$150 copay

04

Medical maximum

Maximum out-of-pocket

In-network$2,950
Combined in + out$2,950
05

Skilled care at home

Home health

In-network$0 cost share
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

CMS reports no Part B premium reduction for this plan.

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkPrimary Care Physician Services: $0 cost share
Out-of-networkNot separately reported

Specialist

In-networkPhysician Specialist Services: $0 cost share
Out-of-networkNot separately reported

Preventive care

In-networkAnnual Physical Exam: $0 cost share; Kidney Disease Education Services: 20% coinsurance; Glaucoma Screening: $0 cost share; Diabetes Self-Management Training: $0 cost share; Digital Rectal Exams: $0 cost share; EKG following Welcome Visit: $0 cost share
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-networkDiagnostic Procedures/Tests: $0 cost share
Out-of-networkNot separately reported

Laboratory services

In-networkLab Services: $0 cost share
Out-of-networkNot separately reported

X-rays & standard imaging

In-networkOutpatient X-Ray Services: $20 copay
Out-of-networkNot separately reported

MRI, CT & PET imaging

In-networkDiagnostic Radiological Services: $150 copay
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkUrgently Needed Services: $30 copay
Out-of-networkNot separately reported

Emergency room

In-network$150 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$300 copay
Out-of-networkNot separately reported

Air ambulance

In-network$300 copay
Out-of-networkNot separately reported

Outpatient hospital

In-networkOutpatient Hospital Services: $250 copay; Observation Services: $300 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

In-networkAmbulatory Surgical Center (ASC) Services: $0 cost share
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

In-network$0 cost share
Out-of-networkNot separately reported

Skilled nursing facility

In-networkSkilled nursing facility: Tier 1: $0 / day for days 1–20; $200 / day for days 21–100
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-networkCardiac Rehabilitation Services: $20 copay; Intensive Cardiac Rehabilitation Services: $20 copay; Pulmonary Rehabilitation Services: $15 copay; SET for PAD Services: $20 copay; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-networkNot separately reported

Occupational therapy

In-networkOccupational Therapy Services: $0 cost share
Out-of-networkNot separately reported

Physical & speech therapy

In-networkPhysical Therapy and Speech-Language Pathology Services: $0 cost share
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

In-networkPartial Hospitalization Program: $0 cost share; Individual Sessions for Mental Health Specialty Services: $0 cost share; Group Sessions for Mental Health Specialty Services: $0 cost share; Individual Sessions for Psychiatric Services: $0 cost share; Group Sessions for Psychiatric Services: $0 cost share; Inpatient psychiatric hospital: Tier 1: $300 / day for days 1–6; $0 / day for days 7–90
Out-of-networkNot separately reported
Point of serviceInpatient psychiatric hospital: Tier 1: $300 / day for days 1–6; $0 / day for days 7–90; $0 per stay

Substance use treatment

In-networkIntensive Outpatient Program Services: $0 cost share; Individual Sessions for Outpatient Substance Abuse: $40 copay; Group Sessions for Outpatient Substance Abuse: $40 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

In-networkPodiatry Services: $0 cost share; 7f(NMC): Not applicable
Out-of-networkNot separately reported

Chiropractic

In-networkChiropractic Services: $15 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

In-networkMedicare Dental Services: $0 cost share; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 cost share; Dental X-Rays: $0 cost share; Other Diagnostic Dental Services: $0 cost share; Prophylaxis (Cleaning): $0 cost share; Fluoride Treatment: $0 cost share; Other Preventive Dental Services: $0 cost share; Restorative Services: 25% coinsurance; Endodontics: 25% coinsurance; Periodontics: 25% coinsurance; Prosthodontics, removable: 25% coinsurance; Prosthodontics, fixed: 25% coinsurance; Oral and Maxillofacial Surgery: 25% coinsurance; Adjunctive General Services: 25% coinsurance
Out-of-networkNot separately reported

Vision

In-networkEye Exams: $0 cost share; Routine Eye Exams: $0 cost share; Other Eye Exam Services: Not applicable; Eyewear: 20% coinsurance; Upgrades: Not applicable
Out-of-networkNot separately reported

Hearing

In-networkHearing Exams: 20% coinsurance; Routine Hearing Exams: Not applicable; Fitting/Evaluation for Hearing Aid: Not applicable; Prescription Hearing Aids (all types): Not applicable; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-networkNot separately reported

Transportation

Not applicable
In-network10b(NMC): Not applicable
Out-of-networkNot separately reported

Fitness & wellness

In-networkFitness Benefit: $0 cost share
Out-of-networkNot separately reported

Over-the-counter allowance

Not applicable
In-networkOver-the-Counter (OTC) Items: Not applicable
Out-of-networkNot separately reported

Meals

Not applicable
In-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · CMS reports no Part B premium reduction for this plan.

Maximum out-of-pocket (MOOP)

In-network$2,950
Combined in + out$2,950

Medical deductibles

In-network$0
Out-of-network$0

Annual health deductible

Not separately reported

Combined network deductible

$0

Part D premium

$0 / month

Network & referrals

HMOPOS · Referrals: Required for some services · Out-of-network coverage: Not reported

Prescription drugs5 tiers

Part D deductible

$370 / year

Drug tier 1

Standard retail: $7 copay · Preferred retail: $0 copay · 30-day supply

Drug tier 2

Standard retail: $15 copay · Preferred retail: $0 copay · 30-day supply

Drug tier 3

Standard retail: $47 copay · Preferred retail: $42 copay · 30-day supply

Drug tier 4

Standard retail: 35% coinsurance · Preferred retail: 35% coinsurance · 30-day supply

Drug tier 5

Standard retail: 29% coinsurance · Preferred retail: 29% coinsurance · 30-day supply

Using this plan

Understand H5943-005-000

Plain-language context built from this plan’s 2027 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

SCAN DaVita Dialysis Care (HMO-POS C-SNP) is a 2027 HMOPOS offered by VillageHealth in Orange, Riverside, and San Bernardino counties. Referrals are required for some services. Its listed inpatient copay stages total $1,800 across 6 charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Primary Care Physician Services: $0 cost share
Specialist
Physician Specialist Services: $0 cost share
Laboratory services
Lab Services: $0 cost share

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
Diagnostic Procedures/Tests: $0 cost share
MRI, CT & PET imaging
Diagnostic Radiological Services: $150 copay
Outpatient hospital
Outpatient Hospital Services: $250 copay; Observation Services: $300 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$150 copay
Listed inpatient stages
$1,800 total

6 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Part B premium reduction (“giveback”)

A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports no Part B premium reduction for this plan.

Availability

Who can enroll

Service area
Orange, Riverside, and San Bernardino counties (CA)
Plan type
HMOPOS
Special Needs Plan
Chronic or Disabling Condition
Contract / plan
H5943-005
Coverage year
2027

This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

DentalMedicare Dental Services: $0 cost share; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 cost share; Dental X-Rays: $0 cost share; Other Diagnostic Dental Services: $0 cost share; Prophylaxis (Cleaning): $0 cost share; Fluoride Treatment: $0 cost share; Other Preventive Dental Services: $0 cost share; Restorative Services: 25% coinsurance; Endodontics: 25% coinsurance; Periodontics: 25% coinsurance; Prosthodontics, removable: 25% coinsurance; Prosthodontics, fixed: 25% coinsurance; Oral and Maxillofacial Surgery: 25% coinsurance; Adjunctive General Services: 25% coinsurance
VisionEye Exams: $0 cost share; Routine Eye Exams: $0 cost share; Other Eye Exam Services: Not applicable; Eyewear: 20% coinsurance; Upgrades: Not applicable
HearingHearing Exams: 20% coinsurance; Routine Hearing Exams: Not applicable; Fitting/Evaluation for Hearing Aid: Not applicable; Prescription Hearing Aids (all types): Not applicable; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Fitness & wellnessFitness Benefit: $0 cost share

Plan-specific answers

Frequently asked questions

Where is H5943-005-000 available?

SCAN DaVita Dialysis Care (HMO-POS C-SNP) is listed for Orange, Riverside, and San Bernardino counties (CA). This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.

What is the in-network maximum out-of-pocket limit for H5943-005-000?

The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $2,950. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H5943-005-000?

The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H5943-005-000?

The plan record lists $150 copay.

Does H5943-005-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2027

Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H5943-005-000 fits

Full CMS plan ID
H5943-005-000
Contract
H5943
Base plan code
H5943-005
Segment
000
Carrier
VillageHealth
Plan type
HMOPOS
Service area
Orange, Riverside, and San Bernardino counties (CA)

County/service-area foundation

CMS service-area entries

Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.

  • Orange, CA
  • Riverside, CA
  • San Bernardino, CA

Exact county navigation

These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.

Show 3 county links

Same CMS contract

H5943-003-000 SCAN DaVita Dialysis Care Complete (HMO-POS C-SNP) Select Southern California Counties · HMOPOS

About this code

What H5943-005-000 identifies

H5943-005-000 is a Contract Year 2027 Medicare plan segment code. Searches written as H5943-005, H5943 005, or the compact full CMS ID H5943005000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.