The Centers for Medicare & Medicaid Services (CMS) requires health plans like SummaCare to provide the cost-sharing subsidy to Medicare beneficiaries who are eligible for low-income subsidies even if our system and the system at CMS do not yet reflect that eligibility.
SummaCare is required to provide you with the tools you need to submit a request to have our system updated to meet your Low Income Subsidy level as awarded to you by the Social Security Administration (SSA). For more information on how to have your subsidy level updated, please call SummaCare Member Service or visit the CMS website and download the appropriate form(s).
For more information about adjusted plan premiums for those who are eligible to get extra help to pay for Medicare prescription drug plan costs, please click on the link below to view our Plan Premium Summary Sheet for Low Income Subsidy:
2025 Plan Premium Summary Sheet for Low Income Subsidy - MAPD
You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call: 1.800.MEDICARE (800.633.4227). TTY/TDD users should call 877.486.2048, 24 hours a day/7 days a week; The Social Security Administration at 800.772.1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call 800.325.0778; or your State Medicaid Office.
SummaCare
P.O. Box 3620
Akron, OH 44309-3620
For other services, equipment and drugs that do require prior authorization, it is your network provider’s responsibility to obtain prior authorization from SummaCare.
SummaCare wants to ensure that you have all the resources you need to prioritize your health. Please review the available options below and how they may be able affect your overall healthcare journey in a positive way.
Designed as a program to help those with limited financial resources pay prescription drug expenses, Extra Help is available to qualifying Medicare members. The financial thresholds for qualifying for Extra Help (also called low-income subsidy (LIS)) as either a single or married individual are listed below:
Single Person:
Annual Income $16,100
Resources $17,600
Married Person:
Annual Income $32,130
Resources $35,130
More information on the Extra Help program including an option to apply for Extra Help is available on the Medicare website at medicare.gov/basics/costs/help/drug-costs.
Medicaid, alongside the Children’s Health Insurance Program (CHIP), jointly administered by federal and state governments, offers health coverage to more than 77.9 million Americans, encompassing children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid stands as the largest single provider of health coverage in the United States.
Under federal law, states are obligated to provide coverage to certain groups to participate in Medicaid. These include low-income families, eligible pregnant women and children, and recipients of Supplemental Security Income (SSI). Additionally, states have the flexibility to extend coverage to other groups, such as those receiving home and community-based services and foster care children who do not meet regular eligibility criteria.
Additional information is available on the Ohio Department of Medicaid’s website, including:
From October 1 - March 31
8:00 a.m. to 8:00 p.m.
seven days a week
From April 1 - September 30
8:00 a.m. to 8:00 p.m.
Monday - Friday
Outside these hours, you may leave us a message and a representative will return your call the next business day.