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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 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:
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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 comprehensive coverage, including inpatient hospital stays with a $250 copay for the first five days, and no copay for days 6-90. Outpatient services, such as hospital visits and ambulatory surgical centers, have a $250 copay, while emergency services have a $120 copay. The plan also covers primary care with copays ranging from $20-$30, preventive services with no copay, and hearing and vision services. This plan provides dental coverage, with a $2,000 annual maximum benefit, and covers home infusion, dialysis, and medical equipment with varying cost-sharing. Additional benefits include ambulance services with a $200 copay, and transportation services with a limit of 50 one-way trips. The plan also covers skilled nursing facility stays with no copay for the first 20 days, and a $196 copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the SummaCare Medicare Amber (HMO) plan, with a $250 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades are 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 ambulatory surgical center (ASC) services have a $250 copay, while individual and group sessions for outpatient substance abuse have a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered by the SummaCare Medicare Amber (HMO) plan, with a copay of $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, with a $200 copay for each service; transportation services to a plan-approved health-related location are also covered, up to 50 one-way trips per year, using a taxi or bus/subway. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the SummaCare Medicare Amber (HMO) plan. Emergency Services have a $120 copay with no coinsurance, while Urgently Needed Services have a $40 copay with no coinsurance. Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $200 copay; all have no coinsurance, and the maximum plan benefit coverage is $25,000.
Primary Care See details
The SummaCare Medicare Amber (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay for individual and group sessions. The plan also covers other health care professionals with a copay between $20 and $30, psychiatric services with a $30 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, and additional telehealth benefits with a copay between $0 and $20. This plan does not cover podiatry services, and routine chiropractic care is not covered.
Preventive Services See details
The SummaCare Medicare Amber (HMO) plan covers preventive services, including Medicare-covered services with no copay and additional preventive services that require a doctor referral and may have a copay. The plan 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, 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 and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $395 and $695, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The SummaCare Medicare Amber (HMO) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The SummaCare Medicare Amber (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, cleaning, fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Restorative services and oral and maxillofacial surgery have a coinsurance between 0% and 50%, while prosthodontics (removable and fixed) have a 50% coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit coverage of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the SummaCare Medicare Amber (HMO) plan with a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits with SummaCare Medicare Amber (HMO) include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance for covered services. Diabetic Therapeutic Shoes/Inserts also have 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, including Diagnostic Procedures/Tests with a $50 copay, Lab Services with a $5 copay, Diagnostic Radiological Services with a copay of at most $125, Therapeutic Radiological Services with at least 20% coinsurance, and Outpatient X-Ray Services with a $50 copay. Radiological Services also have coinsurance, and all services require prior authorization.
Home Health Services See details
Home Health Services are covered by the SummaCare Medicare Amber (HMO) plan with no copay and no coinsurance. However, 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. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits 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.
Other Services See details
The SummaCare Medicare Amber (HMO) plan covers acupuncture with a $20 copay, OTC items with a maximum benefit of $25 every three months, and a meal benefit for chronic illness. Additionally, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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