SummaCare Medicare Ruby (HMO)

Inpatient Hospital See details

Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $260 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $260 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient services include coverage for outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital services, observation services, and ASC services each have a $250 copay, and outpatient substance abuse services have a copay of $40 for both individual and group sessions. Outpatient blood services are not covered.

Partial Hospitalization See details

Partial Hospitalization is covered by SummaCare Medicare Ruby (HMO), with a $40 copay.

Ambulance and Transportation Services See details

Ambulance and Transportation Services, including ground and air ambulance services, are covered by SummaCare Medicare Ruby (HMO). Ground and air ambulance services have a copay of $200, and Transportation Services to a plan-approved health-related location are covered for up to 6 one-way trips per year via taxi or bus/subway, while transportation to any other health-related location is not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. For Emergency Services and Worldwide Emergency Coverage, you will pay a $120 copay, while Urgently Needed Services has a $25 copay and Worldwide Emergency Transportation has a $200 copay. Worldwide Urgent Coverage has a $25 copay. There is no coinsurance for any of these services.

Primary Care See details

The SummaCare Medicare Ruby (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.

Preventive Services See details

The SummaCare Medicare Ruby (HMO) plan covers preventive services, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling (for 5 visits), Fitness Benefit (Memory Fitness, Activity Tracker), Remote Access Technologies, and Kidney Disease Education Services. However, it does not cover Annual Physical Exams, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Support for Caregivers of Enrollees, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, or Counseling Services.

Hearing Services See details

Hearing services are covered, including routine hearing exams with no copay. Prescription hearing aids are covered with a copay between $395 and $695, while inner ear, outer ear, and over the ear prescription hearing aids are not covered.

Vision Services See details

The SummaCare Medicare Ruby (HMO) plan covers vision services, including routine eye exams once per year, with no copay, and eyewear with a combined maximum benefit of $250 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.

Dental Services See details

The SummaCare Medicare Ruby (HMO) plan covers a maximum of $2,000 per year for dental services. Oral exams are covered for up to 2 visits per year, while dental X-rays are covered once per year for bitewing X-rays and once every 5 years for full mouth X-rays.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered under the SummaCare Medicare Ruby (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the SummaCare Medicare Ruby (HMO) plan. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment is covered under the SummaCare Medicare Ruby (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered.

Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies, and also requires authorization. Diabetic Equipment covers Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance, but Diabetic Supplies are not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services, including all diagnostic services and lab services, are covered by the SummaCare Medicare Ruby (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $125, while lab services have no copay. Diagnostic Radiological Services have a copay of $150, and Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services have no copay.

Home Health Services See details

Home Health Services are covered by the SummaCare Medicare Ruby (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the SummaCare Medicare Ruby (HMO) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the SummaCare Medicare Ruby (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203.

Other Services See details

The SummaCare Medicare Ruby (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $60 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered. The plan also covers a meal benefit for chronic illnesses.