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SummaCare Medicare Quartz (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for SummaCare Medicare Quartz (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on SummaCare Medicare Quartz (HMO) in 2026, please refer to our full plan details page.
SummaCare Medicare Quartz (HMO) is a HMO plan offered by Summa Health available for enrollment in 2026 to people living in Northeast Ohio + ER, HU, OT, SA, & SE Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that SummaCare Medicare Quartz (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 Quartz (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 Quartz (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $300.00 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 $3950.00 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 Quartz (HMO) plan features an annual prescription drug deductible of $300. You will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 select care drugs when filled at a preferred pharmacy or through standard mail order. If you use a standard pharmacy instead, these lower-tier drugs require a small copayment ranging from $6 to $10 for a one-month supply. For higher-tier medications, your costs are determined by coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance at preferred pharmacies and 25% coinsurance at standard pharmacies. Tier 4 non-preferred drugs carry a 40% to 50% coinsurance, while Tier 5 specialty drugs require 29% coinsurance regardless of the pharmacy you choose.
Additional Benefits
The SummaCare Medicare Quartz (HMO) plan offers robust medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. For specialist visits, outpatient hospital services, and emergency care, members pay fixed copayments, such as a $30 copay for specialists and a $130 copay for emergency room visits. Inpatient hospital stays require a $325 daily copay for the first few days, after which there is no copay for additional days. This plan also includes valuable supplemental benefits, such as dental care with no copay for preventive services and up to a $2,000 annual maximum for comprehensive care. Routine vision and hearing exams are available with no copay, alongside allowances for eyewear and hearing aids to help minimize out-of-pocket expenses. Additionally, members benefit from a quarterly over-the-counter allowance and up to six one-way medical transportation trips per year with no copay.
Inpatient Hospital See details
SummaCare Medicare Quartz (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, you pay a $325 daily copay for days 1 to 6 and no copay for additional days, while psychiatric stays require a $325 daily copay for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
SummaCare Medicare Quartz (HMO) covers outpatient services with no coinsurance, featuring a $310 copay for outpatient hospital and observation services, and a $270 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by SummaCare Medicare Quartz (HMO) with a $45.00 copay and no coinsurance.
Ambulance and Transportation Services See details
SummaCare Medicare Quartz (HMO) covers ground and air ambulance services with a $320 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, offering up to 6 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
SummaCare Medicare Quartz (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $30 copay and no coinsurance. Worldwide emergency services are covered up to a $25,000 maximum benefit with no coinsurance, carrying copays of $130 for emergency care, $30 for urgent care, and $320 for emergency transportation.
Primary Care See details
SummaCare Medicare Quartz (HMO) offers primary care physician and opioid treatment services with no copay and no coinsurance, while telehealth services feature a $0 to $20 copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and mental health services require a $30 copay and no coinsurance. Chiropractic care is covered with a $20 copay and no coinsurance, though routine chiropractic and podiatry services are not covered.
Preventive Services See details
SummaCare Medicare Quartz (HMO) covers preventive services with no copay and no coinsurance, including Medicare-covered zero-dollar preventive services, kidney disease education, and select screenings. However, preventive benefits are only partially covered under this plan, as an annual physical exam and several supplemental services like in-home safety assessments, weight management, and personal emergency response systems are not covered.
Hearing Services See details
SummaCare Medicare Quartz (HMO) covers hearing services, offering one routine hearing exam per year and unlimited fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $395 to $695 for up to two aids per year, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
SummaCare Medicare Quartz (HMO) provides partially covered vision services with no copay and no coinsurance, though other eye exam services are not covered. Covered benefits include one routine eye exam per year and up to a $150 annual maximum for eyewear, including contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
SummaCare Medicare Quartz (HMO) provides partially covered dental services up to a $2,000 annual maximum, with no copay and no coinsurance for preventive care like exams, cleanings, and x-rays. Covered comprehensive benefits, including restorative care, endodontics, prosthodontics, and oral surgery, have no copay and 0% to 70% coinsurance, while other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
SummaCare Medicare Quartz (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are covered with no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by SummaCare Medicare Quartz (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
SummaCare Medicare Quartz (HMO) covers medical equipment with no copays, requiring a 30% coinsurance for durable medical equipment (DME) and a 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with a 20% coinsurance and no copay for therapeutic shoes and inserts, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
SummaCare Medicare Quartz (HMO) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $125 copay for diagnostic procedures and tests. Radiological services are also covered and require prior authorization, featuring a $75 copay for X-rays, a minimum $175 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by SummaCare Medicare Quartz (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
SummaCare Medicare Quartz (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance. Although some services are covered, standard Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
SummaCare Medicare Quartz (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by SummaCare Medicare Quartz (HMO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $25 every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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