A non-government entity
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 2025, 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 2025.
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:
Sign up for SummaCare Medicare Amber (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by SummaCare Medicare Amber (HMO).
Additional Benefits
The SummaCare Medicare Amber (HMO) plan provides coverage for a variety of services, including inpatient and outpatient hospital care, with specific copays for different services. You'll also find coverage for emergency and urgent care, primary care visits with a $30 copay, and preventive services with no copay. Additional benefits include vision and dental services, with specific allowances and copays. This plan offers coverage for hearing exams with no copay, and partial coverage for hearing aids. You'll also find coverage for home health services with no copay, along with services like ambulance, transportation, and skilled nursing facility (SNF) care, each with its own set of copays or coinsurance. The plan also covers other services such as acupuncture, over-the-counter items, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the SummaCare Medicare Amber (HMO) plan. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-5, and no copay for days 6-90; Inpatient Hospital Psychiatric has a $250 copay for days 1-4, and no copay for days 5-90, with additional days and non-Medicare covered stays not covered.
Outpatient Services See details
Outpatient Services are covered by the SummaCare Medicare Amber (HMO) plan, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital services, observation services, and ASC services have a $250 copay, while individual and group outpatient substance abuse sessions have a $30 copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the SummaCare Medicare Amber (HMO) plan, with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $200 copay, while transportation services to plan-approved health-related locations are covered for up to 50 one-way trips per year, using taxi or bus/subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the SummaCare Medicare Amber (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Worldwide Emergency Transportation has a $200 copay, and Urgently Needed Services and Worldwide Urgent Coverage have a $40 copay; there is no coinsurance for any of these services.
Primary Care See details
The SummaCare Medicare Amber (HMO) plan covers primary care physician services and specialist services with a copay of $30.00, and chiropractic services with a $20.00 copay. The plan also covers occupational therapy, with a $25.00 copay, mental health specialty services with a $30.00 copay for individual and group sessions, and physical therapy with a $25.00 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and additional preventive services with a doctor referral. Additional services such as therapeutic massage have a $20 copay.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are limited to one visit per year. Prescription hearing aids are partially covered, with a copay between $395 and $695 for all types of hearing aids except inner ear, outer ear, and over the ear, which are not covered.
Vision Services See details
The SummaCare Medicare Amber (HMO) plan covers vision services, including routine eye exams once per year. Eyewear has a combined maximum benefit of $300 per year, with coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The SummaCare Medicare Amber (HMO) plan offers dental services with a maximum benefit of $2,000 per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with limits on the number of visits or x-rays allowed, and with no coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the SummaCare Medicare Amber (HMO) plan. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by SummaCare Medicare Amber (HMO), including Durable Medical Equipment with 20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the SummaCare Medicare Amber (HMO) plan. Diagnostic Procedures/Tests have a $50 copay, Lab Services have a $5 copay, Diagnostic Radiological Services have a $125 copay, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the SummaCare Medicare Amber (HMO) plan with no copay and no coinsurance, but 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 Amber (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 Amber (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $196 per day.
Other Services See details
The SummaCare Medicare Amber (HMO) plan covers acupuncture with a $20 copay, and over-the-counter (OTC) items up to $100 every three months, and also offers a meal benefit for chronic illnesses. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved