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SummaCare Medicare Jade with Bene-FlexTM (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SummaCare Medicare Jade with Bene-FlexTM (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SummaCare Medicare Jade with Bene-FlexTM (HMO) in 2025, please refer to our full plan details page.
SummaCare Medicare Jade with Bene-FlexTM (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 Jade with Bene-FlexTM (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 Jade with Bene-FlexTM (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 Jade with Bene-FlexTM (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 $150.00 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 $4500.00 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 Jade with Bene-FlexTM (HMO) plan has an enhanced alternative drug benefit. The plan has a $150 deductible. In the initial coverage phase, you will pay a copay for your prescriptions, depending on the drug tier and pharmacy. For example, standard generic drugs have a $47 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The SummaCare Medicare Jade with Bene-FlexTM (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services, and emergency services. The plan also covers primary care, preventive services, hearing, vision, dental, and home infusion services, as well as medical equipment, diagnostic and radiological services, and skilled nursing facility stays. This plan provides coverage for ambulance and transportation services, with both ground and air ambulance services requiring a copay. It also includes benefits like hearing exams with no copay, and prescription hearing aids with a copay. The plan offers a $3,000 annual maximum for dental services, and also covers home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $305 copay, while individual and group sessions for outpatient substance abuse have a copay between $35.00 and $35.00. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the SummaCare Medicare Jade with Bene-FlexTM (HMO) plan, with a $45 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with both ground and air ambulance services requiring a $290 copay. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year via taxi or bus/subway, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the SummaCare Medicare Jade with Bene-FlexTM (HMO) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
The SummaCare Medicare Jade with Bene-FlexTM (HMO) plan covers Primary Care Physician services, Chiropractic services with a $20 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $35 copay, Mental Health Specialty Services with a $35 copay for both individual and group sessions, Podiatry Services with a $35 copay for routine foot care up to 4 visits per year, Other Health Care Professional services with a minimum $35 copay, Psychiatric Services with a $35 copay for both individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $35 copay, Additional Telehealth Benefits with a $0-$20 copay, and Opioid Treatment Program Services.
Preventive Services See details
The SummaCare Medicare Jade with Bene-FlexTM (HMO) plan covers preventive services including Health Education, Personal Emergency Response System (PERS), Therapeutic Massage (10 sessions per year), Nutritional/Dietary Benefit (4 visits per year), In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling (5 visits), Fitness Benefit, Enhanced Disease Management, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications (up to $400 per year), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, the plan does not cover Annual Physical Exams, In-Home Safety Assessments, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Adult Day Health Services, Home-Based Palliative Care, Support for Caregivers of Enrollees, Telemonitoring Services, and Counseling Services.
Hearing Services See details
Hearing services include hearing exams with no copay, and prescription hearing aids with a copay between $395 and $695, but not prescription hearing aids for the inner ear, outer ear, or over the ear. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited. OTC hearing aids 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 plan benefit of $275 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, with a maximum benefit of $3,000 per year. Oral exams are covered for 2 visits per year, while dental x-rays are covered once per year, and prophylaxis (cleaning) and fluoride treatments are covered for 2 and 1 visits per year, respectively. Restorative Services and Oral and Maxillofacial Surgery have coinsurance between 0% and 20%, while Prosthodontics (removable and fixed) have a 20% coinsurance, and Endodontics is covered once per tooth per lifetime. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the SummaCare Medicare Jade with Bene-FlexTM (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 30% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests have a copay between $0 and $100, while lab services have no copay. Diagnostic radiological services have a copay of at least $150, and therapeutic radiological services have 20% coinsurance. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the SummaCare Medicare Jade with Bene-FlexTM (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the SummaCare Medicare Jade with Bene-FlexTM (HMO) plan. Specifically, 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 with 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
Other Services includes acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture is covered for up to 10 treatments per year. OTC items are covered with a maximum benefit of $85.00 every three months. Meal benefits are covered for a chronic illness. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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