SummaCare Medicare Jade with Bene-FlexTM (HMO)

Ohio Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$12
by SummaCare Medicare Advantage Plans

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.5
out of 5 stars

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Plan Name
SummaCare Medicare Jade with Bene-FlexTM (HMO)
Insurance Carrier
SummaCare Medicare Advantage Plans
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

SummaCare Medicare Jade with Bene-FlexTM (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Ohio and offered by the health insurance company SummaCare Medicare Advantage Plans. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$12
Annual Deductible
$0
Max Out-of-Pocket
$4,500
Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit
ER visit
$120 copay per visit (always covered)
Ambulance
$290 copay

SummaCare Medicare Jade with Bene-FlexTM (HMO) has a monthly premium cost of $12 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,500 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for SummaCare Medicare Jade with Bene-FlexTM (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

SummaCare Medicare Jade with Bene-FlexTM (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. SummaCare Medicare Jade with Bene-FlexTM (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. SummaCare Medicare Jade with Bene-FlexTM (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Limited coverage
Home and bathroom safety devices
Limited coverage
Meals for short duration
Limited coverage
Annual physical exams
Not covered
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, SummaCare Medicare Jade with Bene-FlexTM (HMO) received an overall government quality rating of 4.5 stars out of 5 stars.

SummaCare Medicare Jade with Bene-FlexTM (HMO) performed better than Ohio’s State average overall quality score of 3.9 stars.

This Plan’s 5-star Gov’t Quality Score
Ohio State Average Score
Overall Government 5 Star Quality Rating
 4.5
 3.9
Summary rating of health plan quality
 4.5
 3.9
Staying healthy: screenings, tests, & vaccines
 4
 3.5
Managing chronic (long term) conditions
 4
 3.3
Member experience with health plan
 5
 4.2
Member complaints & changes in the health plan's performance
 5
 4.2
Health plan customer service
 3
 4.0
Summary rating of drug plan quality
 4.5
 3.9
Drug plan customer service
 4
 4.0
Member complaints & changes in the drug plan's performance
 5
 4.1
Member experience with the drug plan
 5
 4.0
Drug safety & accuracy of drug pricing
 3
 3.4

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

SummaCare Medicare Jade with Bene-FlexTM (HMO) received 4.5 stars for its health plan quality score which is better than the Ohio State average health plan quality score of 3.9 stars.

SummaCare Medicare Jade with Bene-FlexTM (HMO) received 4.5 stars for its drug plan quality score which is better than the Ohio State average drug plan quality score of 3.9 stars.


Monthly Premium
$12
Health Portion of Premium
$0
Drug Portion of Premium
$12
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$4,500 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$0-100 copay
Lab services
$0-8 copay
Diagnostic radiology services (like MRI)
$150 copay
Outpatient x-rays
$0-110 copay
Emergency care
$120 copay per visit (always covered)
Urgent care
$25 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$325 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
$305 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$203 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$290 copay

Therapy services

Occupational therapy visit
$35 copay
Physical therapy & speech & language therapy visit
$35 copay

Mental health services

Outpatient group therapy with a psychiatrist
$35 copay
Outpatient individual therapy with a psychiatrist
$35 copay
Outpatient group therapy visit
$35 copay
Outpatient individual therapy visit
$35 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
30% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$8.00 copay$0 copay
Preferred Brand$47.00 copay$0 copay
Non-Preferred Drug$100.00 copay$0 copay
Specialty Tier31% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$0-15 copay
Fitting/evaluation
$0 copay
Hearing aids - All types
$395-695 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
Not covered
Prosthodontics, removable
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Prosthodontics, fixed
In-network: 20% coinsurance
Out-of-network: 20% coinsurance
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
$0 copay
Eyeglass lenses (only)
$0 copay
Upgrades
$0 copay

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