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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 a $250 drug deductible and offers excellent savings on generic medications. For Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs), you will pay no copay for 1-month or 3-month supplies at preferred pharmacies, as well as for 3-month supplies through standard mail order. Standard pharmacy copays for these same tiers range from $6 to $10 for a 1-month supply and $15 to $25 for a 3-month supply. Higher-tier medications require coinsurance rather than flat copays under this plan. Tier 3 (Preferred Brand) drugs carry a 21% coinsurance at preferred pharmacies and a 25% coinsurance at standard pharmacies, while Tier 4 (Non-Preferred) drugs range from 40% to 50% coinsurance. Specialty Tier 5 medications require a 30% coinsurance for a 1-month supply across both preferred and standard pharmacies.
Additional Benefits
The SummaCare Medicare Garnet (HMO) plan offers comprehensive coverage for core medical services, featuring no copay for primary care visits, preventive screenings, and home health services. For specialist visits and outpatient hospital care, members pay predictable copayments, including a $40 copay for specialists and a $340 copay for outpatient hospital services. Inpatient hospital stays require a $346 daily copay for the first six days, followed by no copay for unlimited additional days. In addition to medical care, SummaCare Medicare Garnet (HMO) includes valuable supplemental benefits like routine vision and hearing exams with no copay. Dental services are covered up to a $2,500 annual limit with no copay and coinsurance ranging from 0% to 40%. Members also benefit from a $60 quarterly allowance for over-the-counter items with no copay, making everyday health and wellness needs highly affordable.
Inpatient Hospital See details
SummaCare Medicare Garnet (HMO) covers inpatient acute hospital stays with no coinsurance and a $346 daily copay for days 1 through 6, followed by no copay for unlimited additional days. Inpatient psychiatric stays are covered with no coinsurance and a $346 daily copay for days 1 through 5, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under SummaCare Medicare Garnet (HMO) are covered with no coinsurance, featuring a $340 copay for outpatient hospital and observation services and a $290 copay for ambulatory surgical center services. Outpatient substance abuse services require a $40 copay with 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 ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. Non-emergency transportation services are partially covered with no copay and no coinsurance for up to 4 one-way trips per year to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
SummaCare Medicare Garnet (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have 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.
Primary Care See details
SummaCare Medicare Garnet (HMO) provides primary care and opioid treatment services with no copay and no coinsurance, while specialist, therapy, and mental health visits require a $40 copay and no coinsurance. Telehealth benefits range from a $0 to $20 copay, other healthcare professionals cost $20 to $40, and chiropractic care is $15 with no coinsurance (routine care is not covered), while podiatry services are not covered.
Preventive Services See details
SummaCare Medicare Garnet (HMO) covers preventive services, kidney disease education, and other screenings with no copay and no coinsurance. Additional preventive services are partially covered with no coinsurance—including therapeutic massage for a $20 copay—while annual physical exams, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, adult day health, nutritional benefits, caregiver support, disease management, telemonitoring, home modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by SummaCare Medicare Garnet (HMO), featuring one routine hearing exam per year and unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $395.00 to $695.00 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
SummaCare Medicare Garnet (HMO) covers vision services with no copay and no coinsurance, though other eye exam services are not covered. Covered services include one routine eye exam per year and up to $235 annually toward eyewear, including contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by SummaCare Medicare Garnet (HMO) up to an annual maximum of $2,500. Covered services require no copay and either no coinsurance or 0% to 40% coinsurance, though other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by SummaCare Medicare Garnet (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and standard drugs require a 0% to 20% coinsurance.
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 services.
Medical Equipment See details
SummaCare Medicare Garnet (HMO) covers medical equipment with no copays, though diabetic supplies are not covered under the plan. Durable medical equipment requires a 30% coinsurance, while prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and medical supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by SummaCare Medicare Garnet (HMO) with prior authorization required, featuring no coinsurance for diagnostic services, no copay for lab services, and a $0 to $50 copay for diagnostic procedures. Radiological services require a minimum $125 copay for diagnostic radiology, a minimum 20% coinsurance for therapeutic radiology, and no copay for outpatient X-rays.
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 covered under the SummaCare Medicare Garnet (HMO) with no copay and no coinsurance, but only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
SummaCare Medicare Garnet (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20, followed by a $203 daily copay for days 21 through 100, though prior authorization is required and additional days are not covered.
Other Services See details
SummaCare Medicare Garnet (HMO) partially covers other services, offering acupuncture with a $20 copay and no coinsurance for up to 6 treatments yearly, and over-the-counter items with no copay and no coinsurance up to a $60 limit every three months. Meal benefits are not covered under this plan.
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