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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. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy used. For example, you may pay an $8 copay for a preferred generic drug at a standard pharmacy or 30% coinsurance for a non-preferred drug. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. The plan offers an enhanced alternative drug benefit. If you qualify for the low-income subsidy (LIS), the monthly premium is $24.
Additional Benefits
The SummaCare Medicare Garnet (HMO) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays. The plan also includes coverage for ambulance and transportation services, emergency services, and a variety of primary care services, such as chiropractic and specialist visits, with copays. Additional benefits include preventive, hearing, vision, and dental services, each with specific coverage and limitations. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance. Other covered services include home health, skilled nursing, and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you have a $326 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, there is a $326 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered under the SummaCare Medicare Garnet (HMO) plan. You will pay a $275 copay for outpatient hospital services, observation services, and ambulatory surgical center (ASC) services. Individual and group sessions for outpatient substance abuse have a copay of $40.00. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the SummaCare Medicare Garnet (HMO) plan. The plan has a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the SummaCare Medicare Garnet (HMO) plan. Ground and air ambulance services have a $250 copay, and transportation services to plan-approved health-related locations are covered for 8 one-way trips per year via taxi or bus/subway.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the SummaCare Medicare Garnet (HMO) plan. Emergency Services has a $120 copay, and Urgently Needed Services has a $30 copay, with no coinsurance for either. Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
The SummaCare Medicare Garnet (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 $40 copay, mental health specialty services, psychiatric services, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The SummaCare Medicare Garnet (HMO) plan covers preventive services, with no copay for Medicare-covered services, and additional preventive services that require a doctor referral. Therapeutic massage has a $10 copay. Some services, such as annual physical exams, in-home safety assessments, and counseling services, are not covered.
Hearing Services See details
Hearing services include routine hearing exams with no copay, and fitting/evaluation for hearing aids, covered with no copay. Prescription hearing aids are covered with a copay between $395 and $695, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams once per year, with no copay, and eyewear with a combined maximum plan benefit of $325 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a yearly maximum benefit of $2,500. Oral exams are covered up to 2 times per year, and dental x-rays, prophylaxis (cleaning), fluoride treatments, and endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with varying limitations. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the SummaCare Medicare Garnet (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits under the SummaCare Medicare Garnet (HMO) plan include Durable Medical Equipment (DME) with 30% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The SummaCare Medicare Garnet (HMO) plan covers diagnostic and radiological services with a copay for some services. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $125, and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the SummaCare Medicare Garnet (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not covered in practice. This plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the SummaCare Medicare Garnet (HMO) plan. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture with a $10 copay, and a limit of 6 treatments per year, as well as over-the-counter items with a maximum benefit coverage amount of $85 every three months. The plan also covers meal benefits for chronic illness. However, 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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