SummaCare Medicare Emerald (HMO-POS)

SummaCare Medicare Emerald (HMO-POS) is a HMO-POS plan offered by Summa Health available for enrollment in 2025 to people living in Northeast Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that SummaCare Medicare Emerald (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about SummaCare Medicare Emerald (HMO-POS).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The SummaCare Medicare Emerald (HMO-POS) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies. Standard pharmacies charge copays for these same tiers, ranging from $6 to $10 for a 1-month supply. Tier 3 preferred brand drugs require a $41 copay at preferred pharmacies or a $47 copay at standard pharmacies for a 1-month supply. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring up to 50% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance. Utilizing preferred pharmacies or standard mail order options generally offers the lowest out-of-pocket costs across all drug tiers.

Additional Benefits

The SummaCare Medicare Emerald (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, specialist consultations, and preventive services. For hospital care, inpatient stays require a $205 daily copay for days one through five with no copay thereafter, while outpatient hospital services carry a $190 copay and no coinsurance. Emergency care is covered with a $120 copay, and members also receive up to 12 free one-way transportation trips per year to plan-approved locations. This plan also includes valuable supplemental benefits like dental coverage up to a $2,000 annual limit with no copay for preventive services and 50% to 70% coinsurance for comprehensive care. Vision care features no copay for annual routine exams plus a $300 yearly allowance for eyewear, while hearing benefits include one free annual routine exam and prescription hearing aids with copays ranging from $395 to $695. Additionally, members can access home health services with no copay and receive a quarterly $55 allowance for over-the-counter items.