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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 medical coverage with affordable cost-sharing, including no copay for primary care visits and a $30 copay for specialists. Inpatient hospital stays require a $250 copay for the first few days followed by no copay, while skilled nursing facility stays feature no copay for the first 20 days. Outpatient hospital services generally carry a $250 copay, and there is no coinsurance for these core medical benefits. This plan also provides valuable supplemental benefits, featuring no copay and no coinsurance for routine hearing exams, annual routine vision exams, and preventive dental care up to a $2,000 annual limit. Members also benefit from no copay for up to 50 one-way transportation trips to approved locations and a $25 quarterly over-the-counter allowance. For prescription hearing aids, a copay ranging from $395 to $695 applies with no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by SummaCare Medicare Amber (HMO) with no coinsurance, requiring a $250 copay for days 1 through 5 of acute stays and days 1 through 4 of psychiatric stays, followed by no copay for remaining eligible days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SummaCare Medicare Amber (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 $30 copay with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
SummaCare Medicare Amber (HMO) covers partial hospitalization services with a $40.00 copay and no coinsurance.
Ambulance and Transportation Services See details
SummaCare Medicare Amber (HMO) covers ambulance services with a $200 copay and no coinsurance for both ground and air transportation. Transportation services are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, though trips to any health-related location are 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 with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $25,000 maximum benefit with no coinsurance, requiring copays of $120, $40, and $200 respectively.
Primary Care See details
SummaCare Medicare Amber (HMO) covers primary care and opioid treatment services with no copay and no coinsurance, while specialist, therapy, and mental health visits carry a $30 copay and no coinsurance. Telehealth services are available with a $0 to $20 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
SummaCare Medicare Amber (HMO) preventive services are partially covered, providing Medicare-covered preventive care, kidney disease education, and screenings with no copay and no coinsurance, while therapeutic massage requires a $20 copay and no coinsurance. However, annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
SummaCare Medicare Amber (HMO) covers hearing services, featuring no copay and no coinsurance for routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $395 to $695 for up to two devices per year, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by SummaCare Medicare Amber (HMO), offering one routine eye exam per year and eyewear with no copay, no coinsurance, and no deductible. While eyewear—including contacts and glasses—is covered up to a $300 annual maximum, other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by SummaCare Medicare Amber (HMO), offering up to a $2,000 annual maximum with no copay and no coinsurance for preventive care like exams, cleanings, and x-rays. Covered comprehensive services require no copay and 0% to 50% coinsurance, while orthodontics, implants, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SummaCare Medicare Amber (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while Part B chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
SummaCare Medicare Amber (HMO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
SummaCare Medicare Amber (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. 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
Diagnostic and radiological services are covered by SummaCare Medicare Amber (HMO) with copays ranging from no copay to $50 and no coinsurance for diagnostic tests, alongside a $5 copay and no coinsurance for lab services. Diagnostic radiological services require a minimum $125 copay, outpatient X-rays have a $50 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by SummaCare Medicare Amber (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
SummaCare Medicare Amber (HMO) provides some covered Cardiac Rehabilitation Services with no copay and no coinsurance, though cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
SummaCare Medicare Amber (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $196 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by SummaCare Medicare Amber (HMO), excluding Dual Eligible SNPs with Highly Integrated Services. Covered benefits include acupuncture with a $20 copay and no coinsurance for up to 6 treatments yearly, alongside chronic illness meals and a $25 quarterly over-the-counter allowance, both featuring no copay and no coinsurance.
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