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SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision

SummaCare

Starting at

$618

/month before subsidy

Key facts

SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision is a 2026 Gold HMO health insurance plan from SummaCare, sold on the ACA Marketplace in Ohio under plan ID 52664OH1540006. The monthly premium starts at $618 before subsidies, based on a 40-year-old in the plan's lowest-cost rating area. The individual medical deductible is $2,000 ($4,000 for a family), and the individual out-of-pocket maximum is $6,000 ($12,000 for a family). After the deductible, coinsurance is 20% for covered in-network care. The plan is not HSA-eligible.

Plan ID: 52664OH1540006
Plan year: 2026
State: Ohio
Metal level: Gold
Plan type: HMO
HSA-eligible: No

Individual Deductible

$2,000

Family: $4,000

Out-of-Pocket Max

$6,000

Family: $12,000

Coinsurance

20%

You pay after deductible

Network Type

HMO

OHN001

Cost Sharing

What you pay for common services (after deductible unless noted)

Medical Services

Primary Care Visit$10.00

Specialist Visit$50.00

Urgent Care$75.00

Emergency Room$300.00 Copay after deductible

Prescription Drugs

Generic Drugs$10.00

Brand Name Drugs45.00% Coinsurance after deductible

Specialty Drugs50.00% Coinsurance after deductible

CMS Quality Rating

The federal government's star rating for this plan, based on clinical data and member surveys — the same rating shown on HealthCare.gov.

4.0overall

Medical care
Member experience
Plan administration

What you'd typically pay

Standardized coverage examples from this plan's official Summary of Benefits & Coverage — your estimated out-of-pocket cost in three common situations (in-network).

Having a baby

Normal delivery

$4,170

your estimated cost

Deductible: $2,000
Copays: $10
Coinsurance: $2,100

Managing type 2 diabetes

A year of routine care

$1,220

your estimated cost

Deductible: $900
Copays: $300
Coinsurance: $0

A simple fracture

ER visit + follow-up

$2,220

your estimated cost

Deductible: $2,000
Copays: $200
Coinsurance: $20

Is your medication or doctor covered?

Check this plan against your prescriptions and providers, using live data from the federal Marketplace (CMS). Always confirm with the insurer before enrolling.

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Official Plan Documents

Published by SummaCare. These are the authoritative source for coverage details.

Summary of Benefits & Coverage (SBC)Standardized cost & coverage summary Plan BrochureFull plan details from the insurer Drug FormularyCovered prescriptions & drug tiers

Who This Plan Is Best For

This Gold HMO plan is designed for people who use healthcare frequently and want predictable costs when they visit the doctor.

Consider this plan if you:

Have ongoing health conditions requiring regular care
Take multiple prescription medications
Prefer lower costs at the time of service
Want peace of mind with comprehensive coverage

This summary is generated based on plan attributes for educational purposes only.

Worst-Case Monthly Cost

What you'd pay if you hit your out-of-pocket maximum

If you max out this year

$1,118/month

Annual Premium

$7,416

OOP Maximum

$6,000

💡 What this means:

With a $2,000 deductible, you pay 100% of costs until you've spent that much. After that, you pay 20% (coinsurance) until you hit $6,000 total. Then insurance covers everything else for the year.

More plans from SummaCare in Ohio

View all Marketplace plans in Ohio

Frequently asked questions about SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision

How much does SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision cost per month?

SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision from SummaCare starts at $618 per month before any subsidy in Ohio. Most Marketplace enrollees qualify for a premium tax credit that lowers what they actually pay — estimate your subsidy to see your net premium.

What is the deductible for SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision?

The individual medical deductible is $2,000, and the family deductible is $4,000. You pay for covered care out of pocket until you meet the deductible, after which the plan shares costs with you.

What is the out-of-pocket maximum for SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision?

The most you would pay in a year for covered in-network care is $6,000 for an individual and $12,000 for a family. Once you reach it, the plan pays 100% of covered services for the rest of the year.

Is SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision HSA-eligible?

No. SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision is not classified as an HSA-eligible high-deductible health plan, so it cannot be paired with a Health Savings Account.

What type of network does SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision use?

SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision is a HMO plan. HMO plans generally require you to use in-network providers and to get a referral to see a specialist, in exchange for lower costs.

Understand what you'd actually pay

2026 Federal Poverty Level (FPL) chart
The income table behind subsidy and Medicaid eligibility
How ACA subsidies work
Premium tax credits and who qualifies
The 2026 subsidy cliff
Why income near 400% FPL matters again this year

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Important Notice

Plan details and costs shown are estimates for educational purposes only. Actual costs, coverage, and availability may vary. Always verify plan details and enroll through official channels at HealthCare.gov or your state marketplace.