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SummaCare Medicare Ruby (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SummaCare Medicare Ruby (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SummaCare Medicare Ruby (HMO) in 2026, please refer to our full plan details page.
SummaCare Medicare Ruby (HMO) is a HMO plan offered by Summa Health available for enrollment in 2025 to people living in Northeast & Northwest Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that SummaCare Medicare Ruby (HMO) 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 Ruby (HMO).
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.
For SummaCare Medicare Ruby (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $50.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3600.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The SummaCare Medicare Ruby (HMO) plan features an annual drug deductible of $150 and offers excellent cost savings on lower-tier medications. For Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs), there is no copay for a 1-month or 3-month supply when filled at a preferred pharmacy. Standard pharmacies charge small copays for these same tiers, ranging from $6 to $10 for a 1-month supply. Higher-tier medications require copayments or coinsurance, such as Tier 3 (Preferred Brand) drugs which carry a $41 copay at preferred pharmacies for a 1-month supply. Tier 4 (Non-Preferred Drug) medications require a 40% coinsurance at preferred pharmacies, while Tier 5 (Specialty Tier) drugs require 31% coinsurance across all pharmacy options. Standard mail order options are also available, often matching the lower cost-sharing rates of preferred pharmacies for 3-month supplies.
Additional Benefits
The SummaCare Medicare Ruby (HMO) plan offers robust medical coverage with predictable costs, including no copay for primary care visits and a $35 copay for specialists. For hospital care, inpatient stays require a $260 daily copay for the first few days and no copay thereafter, while outpatient hospital services carry a $250 copay. Emergency care is available with a $120 copay, and standard ambulance services require a $200 copay, both with no coinsurance. This plan also features valuable everyday health benefits, such as home health services and preventive dental care with no copay. Vision and routine hearing exams also have no copay, with additional allowances of up to $250 for eyewear and copays starting at $395 for hearing aids. Furthermore, members benefit from a $75 quarterly over-the-counter allowance and up to six one-way transportation trips per year to approved locations with no copay.
Inpatient Hospital See details
SummaCare Medicare Ruby (HMO) covers inpatient hospital services with no coinsurance, but does not cover upgrades or non-Medicare-covered stays. Acute stays require a $260 daily copay for days 1 through 6 (no copay for days 7 and beyond, including unlimited additional days), while psychiatric stays require a $260 daily copay for days 1 through 5 (no copay for days 6 through 90, with no coverage for additional psychiatric days).
Outpatient Services See details
SummaCare Medicare Ruby (HMO) covers outpatient services with no coinsurance, featuring a $250 copay for outpatient hospital and observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $35 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by SummaCare Medicare Ruby (HMO) with a $40 copay and no coinsurance.
Ambulance and Transportation Services See details
SummaCare Medicare Ruby (HMO) covers ambulance services with a $200 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering no copay or coinsurance for up to 6 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
SummaCare Medicare Ruby (HMO) covers emergency services with a $120 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $25 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 lifetime maximum with no coinsurance and copays of $120, $25, and $200 respectively.
Primary Care See details
SummaCare Medicare Ruby (HMO) covers primary care and opioid treatment services with no copay and no coinsurance, and telehealth benefits are available with a $0 to $20 copay and no coinsurance. Specialist visits, mental health, psychiatric, physical, occupational, and speech therapy services require a $35 copay and no coinsurance, whereas podiatry is not covered, and though some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
SummaCare Medicare Ruby (HMO) covers select preventive services, including kidney disease education, diabetes training, and fitness benefits, with no copay and no coinsurance. This is a partially covered benefit, as annual physical exams, in-home safety assessments, and personal emergency response systems (PERS) are not covered.
Hearing Services See details
SummaCare Medicare Ruby (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Hearing aids are partially covered, with no coinsurance and a $395.00 to $695.00 copay for up to two prescription hearing aids per year, while inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
SummaCare Medicare Ruby (HMO) offers partially covered vision services with no copay, no coinsurance, and no deductible for one routine eye exam and eyewear per year. Eyewear, including contacts and eyeglasses, is covered up to a $250 annual maximum, though other eye exam services are not covered.
Dental Services See details
SummaCare Medicare Ruby (HMO) dental services are covered up to a $2,000 annual limit, offering no copay and no coinsurance for preventive care like cleanings, exams, and x-rays. Comprehensive services are partially covered with no copay and 50% to 70% coinsurance, while other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
SummaCare Medicare Ruby (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the SummaCare Medicare Ruby (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
SummaCare Medicare Ruby (HMO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic equipment is partially covered, offering therapeutic shoes and inserts for no copay and a 20% coinsurance, though diabetic supplies are not covered by the plan.
Diagnostic and Radiological Services See details
SummaCare Medicare Ruby (HMO) covers diagnostic and radiological services with prior authorization required, featuring no coinsurance for diagnostic services, no copay for lab services, and copays between $0 and $125 for diagnostic procedures. Radiological services include outpatient X-rays with no copay, diagnostic radiological services with a minimum $150 copay, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the SummaCare Medicare Ruby (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
SummaCare Medicare Ruby (HMO) covers some services under cardiac rehabilitation with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
SummaCare Medicare Ruby (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20 and a $203 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
SummaCare Medicare Ruby (HMO) provides coverage for select other services with no copay and no coinsurance, including a meal benefit for chronic illnesses and a $75 quarterly allowance for over-the-counter (OTC) items. Acupuncture and other additional services in this category are not covered by the plan.
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