SummaCare Medicare Topaz (HMO)

SummaCare Medicare Topaz (HMO) is a HMO plan offered by Summa Health available for enrollment in 2025 to people living in Northeast Ohio + ER, HU, OT, SA, & SE Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that SummaCare Medicare Topaz (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 Topaz (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.

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 Topaz (HMO) prescription drug plan features an annual drug deductible of $300. 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 or through standard mail order. If you use a standard pharmacy, these same lower-tier drugs require a copay ranging from $6 to $10 for a 1-month supply. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands and Tier 4 non-preferred drugs carry a 23% and 40% coinsurance respectively at preferred pharmacies, which increases to 25% and 50% at standard pharmacies. Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply regardless of whether you use a preferred, standard, or standard mail-order pharmacy.

Additional Benefits

The SummaCare Medicare Topaz (HMO) plan offers affordable healthcare coverage with no copays for primary care visits, home health services, and routine preventive care. For specialized medical needs, members pay a 35 dollar copay for specialists, while inpatient hospital stays require a 375 dollar daily copay for the first several days before transitioning to no copay. Emergency room visits carry a 130 dollar copay, which is waived if admitted, and urgently needed services are available with a 30 dollar copay. This plan also features valuable supplemental benefits, including preventive dental care with no copay and comprehensive dental coverage up to a 3,000 dollar annual limit. Routine vision and hearing exams are covered with no copay, and members receive a 200 dollar annual eyewear allowance alongside an 80 dollar quarterly over-the-counter item benefit. Additionally, skilled nursing facility stays require no copay for the first 20 days of care.