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SummaCare Medicare Garnet (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SummaCare Medicare Garnet (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SummaCare Medicare Garnet (HMO) in 2025, please refer to our full plan details page.
SummaCare Medicare Garnet (HMO) is a HMO plan offered by Summa Health available for enrollment in 2025 to people living in Northeast & Northwest Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that SummaCare Medicare Garnet (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 Garnet (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 Garnet (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.00. 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.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 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
The SummaCare Medicare Garnet (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay an $8 copay for preferred generic drugs at a standard pharmacy, and 30% coinsurance for non-preferred drugs. The plan also offers a $0 copay for specialty tier drugs.
Additional Benefits
The SummaCare Medicare Garnet (HMO) plan offers coverage for a variety of services with varying cost-sharing. You'll find coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $326 depending on the service. The plan also includes benefits for primary care, preventive services, hearing, vision, and dental, with specific copays or coinsurance amounts for each. Additional benefits include ambulance services, emergency care, and home health services, with specific copays for each service. The plan also covers home infusion services, dialysis, and medical equipment with associated cost-sharing. Other covered services include diagnostic and radiological services, skilled nursing facility care, and additional services such as acupuncture, over-the-counter items, and a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you have a $326 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. Inpatient Hospital Psychiatric has a $326 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and ambulatory surgical center services, are covered with a $275 copay. Outpatient substance abuse services are covered with a $40 copay for both individual and group sessions, while outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the SummaCare Medicare Garnet (HMO) plan, with a copay of $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $250 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 8 one-way trips per year, using a taxi or bus/subway, while transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the SummaCare Medicare Garnet (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $30 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The SummaCare Medicare Garnet (HMO) plan covers primary care physician services, chiropractic services with a $20 copay for routine care, occupational therapy services with a $25 copay, physician specialist services with a $40 copay, mental health specialty services and psychiatric services with a $40 copay for individual or group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $20, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered zero-dollar preventive services, additional preventive services, health education, kidney disease education services, and other preventive services, with services like annual physical exams, in-home safety assessment, and several others not covered. The plan covers therapeutic massage with a $10 copay.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams have no copay, and fitting/evaluation for hearing aids are covered, while prescription hearing aids have a copay between $395 and $695 depending on the type of hearing aid. OTC hearing aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year. Eyewear is covered, with a combined maximum benefit of $325 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered, with a yearly maximum of $2,500, and include oral exams (2 per year), dental x-rays, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), restorative services with 0-40% coinsurance, endodontics (once per tooth per lifetime), prosthodontics removable with 0-40% coinsurance, prosthodontics fixed with 0-40% coinsurance, and oral and maxillofacial surgery with 0-40% coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by SummaCare Medicare Garnet (HMO). The plan covers Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the SummaCare Medicare Garnet (HMO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a 30% coinsurance, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies. The plan also covers Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance, but does not cover Diabetic Supplies or Durable Medical Equipment for use outside the home.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay ranging from $0 to $50, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $125 and Therapeutic Radiological Services have a coinsurance of at least 20%, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the SummaCare Medicare Garnet (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 technically covered, however, 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, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The SummaCare Medicare Garnet (HMO) plan covers acupuncture with a $10 copay, and also offers over-the-counter (OTC) items with a maximum coverage amount of $80 every three months. The plan also provides a meal benefit for chronic illness with no cost sharing. Other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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