SummaCare Medicare Topaz (HMO) Medicare Advantage Plan H3660-050 • 2027 • Erie County, OH
- Monthly Premium
- $17.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4650.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $365.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Erie County, OH
- Local Enrollment
- 126 beneficiaries in Erie County
SummaCare Medicare Topaz (HMO) Introduction
CMS Plan ID H3660-050 identifies SummaCare Medicare Topaz, a Medicare Advantage HMO plan offered by SummaCare Medicare Advantage Plans. The plan uses a Health Maintenance Organization (HMO) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $17.00 monthly premium, $0.00 medical deductible, and $4650.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $365.00.
Eligible Medicare beneficiaries residing in Erie County, Ohio can enroll in this plan. CMS reports local enrollment of 126 beneficiaries for this plan in Erie County. New members can contact the plan at (888)464-8440 (TTY (800)750-0750) for help and additional plan information.
Compare Similar Plans in Erie County
Compare this plan with the two most-enrolled HMO plans available in Erie County, Ohio. Enrollment is based on CMS local enrollment data.
| Plan Detail | SummaCare Medicare Topaz | DEVOTED GIVEBACK 003 OH | DEVOTED CORE 022 OH |
|---|---|---|---|
| CMS Plan ID | H3660-050-0 |
H2697-003-0 |
H2697-022-0 |
| Local Enrollment | 126 | 402 | 264 |
| Monthly Premium | $17.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $165 | $0.00 |
| Maximum Out-of-Pocket | $4,650.00 | $8,000.00 | $4,750.00 |
| Part B Giveback | Not offered | −$184.70 reduction | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $35 copay | $45 copay | $15-$35 copay |
| Part D Deductible | $365.00 | $461.00 | $650.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
SummaCare Medicare Topaz includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H3660-050.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3660-050-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $35 copay
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: $0-$20 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $175 copay
- Lab services
- In-network: $0-$10 copay
- Outpatient x-rays
- In-network: $75-$130 copay
- Diagnostic tests and procedures
- In-network: $0-$125 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $30 copay
- Inpatient hospital care
- Tier 1
$370 per day for days 1-6
$0 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- Tier 1
$0 per day for days 1-20
$221 per day for days 21-100 - Ground ambulance
- In-network: $320 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $35 copay
- Outpatient group therapy
- In-network: $35 copay
- Inpatient psychiatric hospital care
- Tier 1
$370 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $35 copay
- Occupational therapy
- In-network: $35 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 30% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- Not covered
- Endodontics
- In-network: $0 copay
- Restorative services
- In-network: 0%-20% coinsurance
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: 0%-20% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- In-network: $0 copay
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $395-$1895 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- In-network: $0 copay
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by SummaCare Medicare Topaz as a Part B benefit.
Prescription Drug Coverage
SummaCare Medicare Topaz includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $15.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $15.00 |
| Low-Income Premium Subsidy: | $21.05 |
| Low-Income Premium Subsidy Paid by CMS: | $15.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $365.00 annual Part D deductible. You'll pay this deductible at the pharmacy before SummaCare Medicare Advantage Plans starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, SummaCare Medicare Topaz may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 23% coinsurance | Coming soon |
| Non-Preferred Drug | 33% coinsurance | Coming soon |
| Specialty Tier | 29% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H3660)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for SummaCare Medicare Advantage Plans
- Website
- SummaCare Medicare Advantage Plans Plan Page
- Providers
- SummaCare Medicare Advantage Plans Providers Page
- Formulary
- SummaCare Medicare Advantage Plans Formulary Page
- Pharmacy
- SummaCare Medicare Advantage Plans Pharmacy Page
- New Member Health Plan Help
- (888)464-8440
- New Member Health Plan TTY
- (800)750-0750
- New Member Part D Help
- (888)464-8440
- New Member Part D TTY Users
- (800)750-0750
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| SummaCare Medicare Advantage Plans (official source) | http://www.summacare.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| Medicare.gov | Joining a plan | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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