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SummaCare Medicare Amber (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SummaCare Medicare Amber (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SummaCare Medicare Amber (HMO) in 2026, please refer to our full plan details page.
SummaCare Medicare Amber (HMO) is a HMO plan offered by Summa Health available for enrollment in 2025 to people living in Northern Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that SummaCare Medicare Amber (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about SummaCare Medicare Amber (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 Amber (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3450.00 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
Prescription drugs are not covered by SummaCare Medicare Amber (HMO).
Additional Benefits
The SummaCare Medicare Amber (HMO) plan offers robust coverage with predictable, low out-of-pocket costs for essential medical services. Members pay no copay for primary care visits, standard preventive screenings, and home health services, while specialist visits require a $30 copay. For inpatient hospital stays, there is no coinsurance and a $250 daily copay for the first few days, while emergency room visits carry a $120 copay that is waived if you are admitted. This plan also features strong supplemental benefits, including no copay for routine vision exams, up to $300 annually for eyewear, and up to $2,000 yearly for preventive dental care with no copay. Additionally, members benefit from no copay on routine hearing exams, up to 50 one-way transportation trips to approved health locations with no copay, and a $100 quarterly allowance for over-the-counter items. Other services like medical equipment and dialysis require no copay but feature a 20% coinsurance.
Inpatient Hospital See details
SummaCare Medicare Amber (HMO) covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 through 5 of acute stays and days 1 through 4 of psychiatric stays, followed by no copay. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
SummaCare Medicare Amber (HMO) covers outpatient services with no coinsurance, featuring a $250 copay per stay for outpatient hospital and observation services and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 copay per individual or group session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by SummaCare Medicare Amber (HMO) with a $40.00 copay and no coinsurance.
Ambulance and Transportation Services See details
SummaCare Medicare Amber (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
SummaCare Medicare Amber (HMO) covers emergency services with a $120 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 maximum benefit with copays ranging from $40 to $200 and no coinsurance.
Primary Care See details
SummaCare Medicare Amber (HMO) covers primary care physician and opioid treatment services with no copay and no coinsurance, while specialist, mental health, and psychiatric visits require a $30 copay and no coinsurance. Physical, occupational, and speech therapy require a $25 copay with no coinsurance, telehealth ranges from a $0 to $20 copay with no coinsurance, but podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by SummaCare Medicare Amber (HMO) with no copay and no coinsurance for standard Medicare-covered screenings and kidney disease education. Additional preventive benefits are partially covered with no coinsurance and require a referral, including fitness programs and therapeutic massage for a $20 copay and no coinsurance, though annual physical exams, weight management, and personal emergency response systems are not covered.
Hearing Services See details
SummaCare Medicare Amber (HMO) hearing services are partially covered, offering routine hearing exams and fittings with no copay and no coinsurance. Covered prescription hearing aids require no coinsurance and a copay ranging from $395 to $695 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by SummaCare Medicare Amber (HMO) with no copay, no coinsurance, and no deductible, though eye exams are only partially covered because other eye exam services are not covered. Covered services include one routine eye exam per year and eyewear, such as contact lenses, eyeglasses, and upgrades, up to a combined maximum of $300 every year.
Dental Services See details
Dental services are partially covered by SummaCare Medicare Amber (HMO), featuring an annual maximum benefit of $2,000 with no copay and no coinsurance for preventive care such as cleanings and exams. Comprehensive services are covered with no copay and coinsurance ranging from 0% to 50%, but other diagnostic or preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
SummaCare Medicare Amber (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B chemotherapy and radiation drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by SummaCare Medicare Amber (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
SummaCare Medicare Amber (HMO) covers medical equipment, including durable medical equipment (DME), prosthetic devices, and medical supplies, with no copay and a 20% coinsurance, though prior authorization is required. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
SummaCare Medicare Amber (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and lab services feature no coinsurance and copays ranging from $0 to $50, while radiological services require a $50 copay for X-rays, a minimum $125 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
SummaCare Medicare Amber (HMO) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice by the SummaCare Medicare Amber (HMO) plan. While the benefit technically features no copay and no coinsurance, all specific sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by SummaCare Medicare Amber (HMO) with no coinsurance and require prior authorization, with no prior three-day inpatient hospital stay required. There is no copay for days 1 through 20 and a $196 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SummaCare Medicare Amber (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 6 treatments per year, alongside over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. OTC benefits feature a $100 allowance every three months, though other unspecified services under this category are not covered.
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