SummaCare Medicare Emerald (HMO-POS) Medicare Advantage Plan H3660-028 • 2027
- Monthly Premium
- $159.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3000.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $50.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 611 beneficiaries
SummaCare Medicare Emerald (HMO-POS) Introduction
CMS Plan ID H3660-028 identifies SummaCare Medicare Emerald, a Medicare Advantage HMO-POS plan offered by SummaCare Medicare Advantage Plans. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $159.00 monthly premium, $0.00 medical deductible, and $3000.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $50.00.
Plan Benefits
SummaCare Medicare Emerald 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 H3660-028.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $20 copay |
In-network: $0 copay Out-of-network: $20 copay |
| Specialist | In-network: $0 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $40 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | Not covered | Not covered |
| Telehealth benefit | In-network: $0-$20 copay | In-network: $0-$20 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay | In-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $100 copay Out-of-network: 30% coinsurance |
In-network: $100 copay Out-of-network: 30% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Outpatient x-rays | In-network: $0-$75 copay Out-of-network: 30% coinsurance |
In-network: $0-$75 copay Out-of-network: 30% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$75 copay Out-of-network: 30% coinsurance |
In-network: $0-$75 copay Out-of-network: 30% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $120 copay | $120 copay |
| Worldwide emergency care | Coming soon | $120 copay |
| Urgent care | $25 copay | $25 copay |
| Inpatient hospital care | In-network: Tier 1 $205 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 20% per day for days 1-90 0% per stay |
In-network: Tier 1 $205 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 20% per day for days 1-90 0% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $188 per day for days 21-100 Out-of-network: $188 per day for days 1-100 $0 per stay |
In-network: Tier 1 $0 per day for days 1-20 $188 per day for days 21-100 Out-of-network: $188 per day for days 1-100 $0 per stay |
| Ground ambulance | In-network: $200 copay Out-of-network: $200 copay |
In-network: $200 copay Out-of-network: $200 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $0 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $40 copay |
| Outpatient group therapy | In-network: $0 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $40 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $205 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 20% per day for days 1-90 0% per stay |
In-network: Tier 1 $205 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 20% per day for days 1-90 0% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $0 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $40 copay |
| Occupational therapy | In-network: $0 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $40 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay Out-of-network: 30% coinsurance |
In-network: $0 copay Out-of-network: 30% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 20% coinsurance Out-of-network: 30% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 30% coinsurance |
In-network: 20% coinsurance Out-of-network: 30% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 30% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 copay |
| Cleaning | In-network: $0 copay | In-network: $0 copay |
| Periodontics | Not covered | Not covered |
| Endodontics | In-network: 50% coinsurance | In-network: 50% coinsurance |
| Restorative services | In-network: 50%-70% coinsurance | In-network: 50%-70% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 50%-70% coinsurance | In-network: 50%-70% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $40 copay |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $40 copay |
In-network: $0 copay Out-of-network: $40 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $395-$1895 copay | In-network: $395-$695 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | In-network: $0 copay | In-network: $0 copay |
| Personal emergency response system | Coming soon | In-network: $0 copay |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | In-network: $10 copay |
| Home/bathroom safety devices | In-network: $0 copay | In-network: $0 copay |
Certain preventive services are covered 100% by SummaCare Medicare Emerald as a Part B benefit.
Prescription Drug Coverage
SummaCare Medicare Emerald 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: | $65.70 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $65.70 |
| Low-Income Premium Subsidy: | $21.05 |
| Low-Income Premium Subsidy Paid by CMS: | $21.10 |
| Low-Income Subsidy Premium: | $44.60 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $50.00 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 Emerald 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 | 39% coinsurance | Coming soon |
| Specialty Tier | 32% 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.
Plan Availability
SummaCare Medicare Emerald (H3660-028-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About SummaCare Medicare Emerald (HMO-POS)
How much does plan H3660-028 cost per month?
The plan’s monthly premium is $159.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
For 2027, the in-network maximum out-of-pocket is $3000.00. The plan pays 100% of covered in-network services beyond this amount.
What is the star rating for plan H3660-028 in 2027?
For 2027, plan H3660-028 has a CMS star rating of ★4.0 out of 5 stars.
How many beneficiaries are enrolled in this plan?
CMS reports 611 beneficiaries enrolled in this plan.
Is there a Part D deductible for this plan?
The Part D deductible is $50.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | November 10, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | November 10, 2026 |
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 | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
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