Posted April 03, 2025 by Matt Baker - Director of Sales
Matt Baker, Director of Sales at SummaCare
Learn about the four plan tiers—Bronze, Silver, Gold, and Catastrophic—and what makes each one unique.
Understand SummaCare’s HMO structure and how in-network care is coordinated for members.
Get a breakdown of top hospitals in the SC Connect network across Stark, Summit, Medina, and Portage counties.
Matt shares an easy online tool at www.summacare.com/find-your-doctor-or-hospital.
From primary care visits to mental health support, Teladoc Health®, gym discounts, and wellness coaching—SummaCare offers more than just basic coverage.
Discover why SummaCare earned a 5 out of 5 star rating from the Health Insurance Marketplace.
Learn how subsidies and tax credits can help lower the cost for eligible individuals and families.
Understand what counts as a qualifying life event and how to take the next step toward coverage.
Scott Webb (Host): Hi folks. Scott Webb here. We've invited Matt Baker, Director of Sales at SummaCare to our talk today to give us the 411 on how SummaCare's Individual and Family plans can work for you. If you're looking to trade up or enroll in a new health insurance plan that's packed with benefits that feel personalized to you, you've come to the right spot.
Get ready to take a deep dive into SummaCare's Individual and Family Marketplace plans for lots of insight without all the heavy reading. Sound good? We think so too. Let's get started.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.
Matt, it's great to have you here today. We're going to talk about SummaCare Insurance, the marketplace plans, and you know, break everything down. Give folks the 411. So first things first, what types of individual and family plans does SummaCare offer?
Matt Baker: Scott, thanks for having me. So yeah, we have four tiers of plans from bronze, silver, gold, and then catastrophic, with high value benefits, just like the precious metals are named after. But at a far more modest price point.
Host: Yeah, it's great to hear, and I definitely can understand you use that analogy, you know, the precious metals. Interested in learning more already, so maybe you can share some of the details about the plans.
Matt Baker: So when you become a SummaCare member, you'll be a part of a health maintenance organization or HMO plan and part of the SummaCare Connect network. So this means that the care you receive takes place with any set network of providers, except for visits to the ER or urgent care. An added plus is that you won't need a referral to see a specialist which is a nice to have benefit that saves you time and money.
Host: Yeah, and you mentioned a provider network. What providers and hospitals are included in the SC Connect network?
Matt Baker: Yeah, that's a great question. So the SC Connect network covers members in Stark, Summit, Medina and Portage County, and it gives them access to an exclusive network of providers, facilities, and hospitals, including ones that you already know, like Summa Health, Cleveland Clinic, Mercy Hospital in Canton, and then the Akron Children's Hospital just to name a few.
Host: Yeah. Matt, and is there a way to check and see if our provider is a part of the SC Connect Network before we enroll?
Matt Baker: Absolutely. It's easy to do. You just have to visit summacare.com/findyourdoctororhospital, and that should take you to the list of where you can do that research.
Host: All right, so far so good. Great care plus access to lots of close to home providers and hospitals. But what about the plan? What benefits can we expect if we enroll?
Matt Baker: Well, for starters, you get comprehensive medical and pharmacy coverage. There are three no cost primary care office visits for each year and outpatient mental health services. So not just for you, but also for every member or person on your policy. There are low copays for primary care visits and generic prescriptions at the pharmacy.
You can get a hundred dollars Vision hardware allowance through VSP on many of our plans, plus access to telehealth at participating and in-network providers via Teladoc. And then that's not all you get. With SummaCare, there are health and wellness benefits too. And that includes condition management programs for chronic conditions, health coaching, preventive health reminders for appointments, no cost vaccines, Web MDs health manager that help set goals and monitor health progress and tracks results and set reminders. Also Quit Care for smokers and gym discounts through HUS program.
Host: Sounds great, but how do we know SummaCare plans actually stack up and this isn't all talk Matt?
Matt Baker: Well, I appreciate that question and I'm happy to provide an answer. So in 2025, our individual and family plans earned a five out of five overall star rating from the health insurance marketplace. So that's a full score, meaning that we've scored at the very top.
Host: Okay, but what does it really mean, Matt?
Matt Baker: So the ratings determined by the health insurance marketplace and they evaluate the quality of healthcare services and member experiences, from the perspective of existing members who are people like you and me. The ratings are evaluated based on three categories, so member experience, medical care, and plan administration.
So getting a five out of five star overall rating means members who are currently enrolled in SummaCare individual and family plans are very satisfied with the services and care they're receiving. It's a good sign that you might be too.
Host: Yeah. It sounds like SummaCare has really great plans, but I'm wondering, you know, if money's tight, what if we can't swing the cost?
Matt Baker: So cost factors into just about everything these days. I mean, if you think about it, grocery costs are going up and gas and so forth. So that's why SummaCare offers subsidies to help buffer plan costs for those who qualify. So the subsidy is available as an advanced premium tax credit or cost share subsidy.
So a few factors go into the application process. So you'll need to be under the age of 65 and can't be eligible for coverage through your employer, Medicare or Medicaid. And if you're approved, it could really help cut down those costs.
Host: Yeah. And as we get close to finishing up here, Matt, I'm betting a lot of our listeners are interested in enrolling after hearing about all these benefits. So who's eligible to enroll right now?
Matt Baker: Well, that's great to hear and I, in order to enroll in SummaCare right now, you'll need to have what's called a qualifying life event. So that could be a divorce, moving, aging off your parents' insurance, retirement at a pre-Medicare age, if you have a baby or a few other events. So for more information, visit summacare.com/market placeradio, or you can call SummaCare at (888) 291-3787.
And we have representatives, that are here to talk and simplify the processes. And always happy to answer questions because at SummaCare we really believe that it's a personal approach to making sure you get what you need.
Host: Well thanks Matt. I appreciate you breaking down the medical coverage and benefits offered through SummaCare's individual and family plans.
Plus the exclusive network of providers and hospitals that members gain access to, health and wellness perks, available subsidies for those who qualify that can help cut costs. And the excellent five out of five star overall rating that's determined by members already on the plan and ranked by the health insurance marketplace.
Thanks for being here. And of course, we'd like to thank our listeners as always for spending a little time with us today to learn about the benefits of SummaCare individual and family marketplace plans. We value all of you and appreciate the listen. If you liked what you heard, feel free to share this podcast with friends and family.
Follow SummaCare on Facebook or Instagram, or learn more about the specifics of SummaCare individual and family plans at summacare.com/marketplaceradio. And thanks again for listening in.