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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 2026, 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 2026.
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 $35.00. 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 $250.00 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 $4800.00 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 features an annual drug deductible of $250. You can save on prescriptions by using preferred pharmacies or standard mail order services, which offer no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs. Filling these same lower-tier medications at a standard pharmacy results in copays ranging from $6 to $10 for a one-month supply. For higher-tier medications, your costs will be calculated as a percentage of the drug cost. Tier 3 preferred brand drugs require a 21% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs require 40% to 50% coinsurance. Specialty Tier 5 medications carry a consistent 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The SummaCare Medicare Garnet (HMO) plan offers robust medical coverage with no copay for primary care visits, cardiac rehabilitation, and home health services. Specialists, outpatient hospital services, and emergency care are covered with predictable flat copayments and no coinsurance, while inpatient hospital stays require a daily copay for the first few days before transitioning to no copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care is available with a $30 copay. For everyday wellness, the plan features no copay for routine vision and hearing exams, along with a $2,500 annual dental allowance that features no copays and coinsurance up to 40%. Beneficiaries also receive a quarterly $60 allowance for over-the-counter items with no copay, as well as no copay for the first 20 days of a skilled nursing facility stay. Durable medical equipment and dialysis services are covered with coinsurance and no copays, ensuring comprehensive support for your ongoing health needs.
Inpatient Hospital See details
SummaCare Medicare Garnet (HMO) covers inpatient hospital services with no coinsurance, requiring a $346 daily copay for days 1 through 6 for acute stays and days 1 through 5 for psychiatric stays, with no copay for subsequent days. While unlimited additional acute days are covered at no cost, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
SummaCare Medicare Garnet (HMO) covers outpatient hospital and observation services with a $340 copay and no coinsurance, and ambulatory surgical center services with a $290 copay and no coinsurance. Outpatient substance abuse individual and group sessions require a $40 copay and no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
SummaCare Medicare Garnet (HMO) covers partial hospitalization services with a $45.00 copay and no coinsurance.
Ambulance and Transportation Services See details
SummaCare Medicare Garnet (HMO) covers ambulance services with a $250 copay and no coinsurance for both ground and air transportation. Transportation services are partially covered with no copay and no coinsurance for up to 4 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
SummaCare Medicare Garnet (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care has a $30 copay and no coinsurance, while worldwide emergency services are covered up to a $25,000 maximum benefit with no coinsurance and copays ranging from $30 to $250 depending on the service.
Primary Care See details
SummaCare Medicare Garnet (HMO) offers primary care and opioid treatment services with no copay and no coinsurance, while specialists, therapies, and mental health services require a $40 copay and no coinsurance. Telehealth services feature a $0 to $20 copay with no coinsurance, chiropractic care is partially covered with a $15 copay and no coinsurance (routine and other chiropractic services are not covered), and podiatry services are not covered.
Preventive Services See details
SummaCare Medicare Garnet (HMO) provides partial coverage for preventive services, featuring no copay and no coinsurance for Medicare-covered zero-dollar preventive care, kidney disease education, and select screenings. While additional benefits like health education and memory fitness have no coinsurance but require a referral, therapeutic massage requires a $20 copay for up to six annual sessions, and several services including annual physical exams and weight management programs are not covered.
Hearing Services See details
SummaCare Medicare Garnet (HMO) covers hearing services with no copay and no coinsurance for one routine hearing exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $395 to $695 for up to two aids per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
SummaCare Medicare Garnet (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible. This coverage includes one routine eye exam per year and up to $235 annually for eyewear, contacts, and upgrades, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by SummaCare Medicare Garnet (HMO) up to an annual maximum of $2,500, featuring no copay on all covered services and coinsurance ranging from no coinsurance up to 40%. Sub-services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
SummaCare Medicare Garnet (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin carries a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the SummaCare Medicare Garnet (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
SummaCare Medicare Garnet (HMO) partially covers medical equipment with no copays, though diabetic supplies are not covered. Covered durable medical equipment requires a 30% coinsurance, while covered prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
SummaCare Medicare Garnet (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and tests have no coinsurance and a $0 to $50 copay, while lab services and outpatient X-rays feature no copay. Diagnostic radiological services require a minimum $125 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by SummaCare Medicare Garnet (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by SummaCare Medicare Garnet (HMO) with no copay and no coinsurance. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
SummaCare Medicare Garnet (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $203 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
SummaCare Medicare Garnet (HMO) partially covers other services, offering acupuncture for a $20.00 copay and no coinsurance up to six treatments per year, and over-the-counter (OTC) items with no copay and no coinsurance up to $60.00 every three months. Meal benefits are not covered under this plan.
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