SummaCare's Ruby (HMO) Medicare Advantage plan is designed for individuals seeking even lower out-of-pocket costs, enhanced supplemental benefits, Part D prescription coverage plus health and wellness perks. Additional plan details include:
This plan includes Part D prescription drug coverage.
For an additional $37 per month, you can purchase supplemental dental coverage.
This plan's Part D prescription drug coverage includes $0 copays for Tier 1, 2 and 6 drugs** at preferred pharmacies.
Through our partnership with Delta Dental of Ohio, you’re covered for a wide variety of services including cleanings, fluoride treatments, X-rays, exams, fillings, simple extractions and root canals. Coverage for bridges, crowns and dentures is also available. Optional Supplemental Dental coverage can be purchased for an additional monthly premium.
You’ll receive an annual reimbursement amount of $250 to use toward the purchase of frames/lenses or contact lenses with the freedom to purchase anywhere you choose. Coverage also includes diagnostic and routine vision exams for a $0 copay.
You’re covered for one hearing aid per ear every year from our formulary, after paying $395 per hearing aid for Level 1 hearing aids and $695 per hearing aid for Level 2 hearing aids. And, one annual hearing exam is covered for a $0 copay.
Every member will receive a SummaCare &more card*** with which to spend your various Benefit Bucks, including Over-the-Counter (OTC) Allowances and Preventive Care Rewards. You'll receive a quarterly amount of $75 to spend on non-prescription OTC health-related items. Your OTC quarterly allowance can be used to obtain health-related items over the phone, online or in person at more than 70,000+ participating retailers nationwide. Rewards are loaded automatically to your SummaCare &more card approximately 90 days after claims are paid.
Through our visitor/travel benefit, members receive in-network coverage levels (for most benefits) when visiting a Medicare-participating provider in Arizona, Florida, North Carolina, South Carolina or Texas. Whether you’re a snowbird or regularly travel, go with confidence knowing you’re covered. Note: You must still use SummaCare network providers for certain supplemental benefits for in-network coverage to apply.
Our plans also have built-in worldwide emergency, urgent care coverage and ambulance services, so you can travel close to home or around the world, worry-free.
Members experiencing chronic lower back pain are eligible to receive up to a maximum of 20 Medicare-covered acupuncture treatments per year at a $35 copay per visit.
Receive supplies to monitor your blood glucose including test strips, lancet devices and lancets, and solutions for no cost when using Abbott and/or Ascensia Contour products.
Health Coaching is a one-on-one telephonic service to help you identify at-risk behaviors and provide suggestions to improve your wellness.
Condition Management includes a registered nurse helping you learn how to better manage your chronic condition and how to maintain and improve your quality of life.
Once you're a member, you’ll get exclusive access to WebMD’s Health Manager online tool. Set personal goals, monitor your health progress, track results, set personal health and wellness reminders. It’s like having a personal health coach working with you 24/7.
SummaCare can offer support to smokers who are ready to kick the habit. Quitting specialists will enroll members in the no cost QuitCare counseling program. Members may choose to receive a limited supply of nicotine replacement therapy at no cost.
Do you sometimes forget to schedule regular check-ups? Once you're a member, we’ll send you reminders for preventive services and other recommended care for common conditions.
Hang Out and Help Out. Papa pairs older adults and families with Papa Pals for companionship and assistance with everyday tasks. Get up to 40 hours of help around the house, including light housework, a ride to the doctor’s office, pharmacy (or anywhere around town), help with errands or simply someone to talk to. Providing support to SummaCare Medicare Advantage members also offers relief and respite to caregivers.
You’re covered for telehealth visits with primary care providers, specialists and/or behavioral health and substance abuse providers. Visits can be scheduled through in-network providers or through Teladoc® Health. Most Teladoc® Health visits can be scheduled 24 hours a day, 365 days a year.
You may qualify for $175 for home safety devices, such as grab bars, shower stools and more. If you have had within the last 12 months, any of the following: hip replacement, knee replacement or femur fractures; or a diagnosis of falls, as documented by provider, you are eligible for home safety devices.
You’re covered for 6 one-way trips to medical appointments. Most trips can be scheduled in as little as 30 minutes and you can see providers throughout SummaCare’s 33-county service area.
Note: SummaCare's transportation vendor may utilize other ride share vendors like Lyft and Uber to fulfill your transportation request.
In the simplest of terms, BrainHQ is an online, evidence-based program to address your overall brain health. BrainHQ has dozens of exercises that have been scientifically proven to help people think faster, focus better and remember more. BrainHQ adjusts to meet the needs of your unique brain over time, providing the best exercises at the right pace your brain needs to be at its sharpest.
You’ll have access to a registered nurse 24 hours a day, seven days a week who can answer your medical questions.
All SummaCare Medicare Advantage plans include a SilverSneakers® membership at no added cost. SilverSneakers is more than a traditional fitness program. It’s a way to improve your health and live the life you want. Whether you enjoy group fitness classes, sports, using strength and cardio equipment or prefer staying active at home, SilverSneakers gives you the opportunity to improve your health, gain confidence and connect with your community.
You are covered for meals that fuel healthy living! Following a hospital stay or if you have diabetes with a high A1C level (over 8), you can receive up to 14 home-delivered, nutritious meals to help you focus on rest and recovery. Meals must be obtained through Mom’s Meals.
$0
$35
Is my doctor covered?
Our plan covers many preventive services where you pay nothing. See the Summary of Benefits below for the full list.
No, except emergency, urgent and out-of-area renal dialysis.
$260 per day, for days 1 through 6. You pay nothing after day 6.
Ambulatory Surgical Center: $200
Outpatient Hospital: $250
Observation Services: $250
$120 per visit
$25 per visit
$150
$0 - $125, depending on location
$0 - $8, depending on location
$0 - $110, depending on location
20% of the cost
Retail 1-Month Supply
Preferred: $0 copay
Standard: $6 copay
Retail/Mail-Order 3-Month Supply
Preferred: $0 copay
Standard: $15 copay
Retail 1-Month Supply
Preferred: $0 copay
Standard: $10 copay
Retail/Mail-Order 3-Month Supply
Preferred: $0 copay
Standard: $25 copay
Retail 1-Month Supply
Preferred: $41 copay
Standard: $47 copay
Retail/Mail-Order 3-Month Supply
Preferred: $102.50 copay
Standard: $117.50 copay
Retail 1-Month Supply
Preferred: 40% of the cost
Standard: 50% of the cost
Retail/Mail-Order 3-Month Supply
Preferred: 40% of the cost
Standard: 50% of the cost
Retail 1-Month Supply
Preferred: 31% of the cost
Standard: 31% of the cost
Retail/Mail-Order 3-Month Supply
A long-term supply is not available for drugs in Tier 5
Retail 1-Month Supply
Preferred: $0 copay
Standard: $6 copay
Retail/Mail-Order 3-Month Supply
Preferred: $0 copay
Standard: $15 copay
You’re covered for a wide variety of services including cleanings, fluoride treatments, X-rays, exams, fillings, simple extractions and root canals. Coverage for bridges, crowns and dentures is also available. Optional Supplemental Dental coverage can be purchased for an additional monthly premium of $37. For full details and exclusions, view your dental handbook at summacare.com/plandocuments.
$0
$0
$250
$0
$0
$0
$0 - $15, depending on location
$0
$395 (Level 1) or $695 (Level 2) per Hearing Aid, Limit one per ear every year
Other Enrollment Materials
A Medicare Advantage plan or Medicare Part C coverage is an all-in-one bundled healthcare plan that's offered through private insurance companies, like SummaCare, for those who are Medicare-eligible. With a Medicare Advantage plan (Part C), you gain bundled hospital (Part A), medical (Part B) and, usually, Part D prescription coverage plus dental, hearing and vision benefits included in one plan premium.
An HMO plan typically only covers in-network benefits. To receive in-network benefits, you must seek care exclusively from providers in your network. With an HMO plan, you will be responsible for paying the cost of all care that is provided by non-network/out-of-network providers unless the care you receive from the non-network/out-of-network providers is pre-authorized or is for emergency or urgent care services.
An HMO-POS is similar to an HMO plan but allows you the flexibility to seek care from any Medicare-approved provider, though your out-of-pocket costs may be higher if you see providers outside of your network.
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We're continually expanding our coverage, so please check back soon, or contact us to learn more about future availability.
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