SummaCare
SummaCare is an Ohio-based, for-profit health insurance company founded in 1993 that underwrites Medicare Advantage HMO/HMO-POS plans, Individual and Family plans, and employer group PPO products across 25 northern Ohio counties, distributing through direct sales, brokers, and the federal marketplace with 4.5-star CMS ratings.
- Company typePrivate
- Founded1993
- HeadquartersAkron, United States
- Headcount251–500
- GTM typeB2B
- OfferingServices
What SummaCare does
SummaCare, Inc. is an Ohio-domiciled, for-profit health insurance company headquartered in Akron that has operated since 1993 and is affiliated with Summa Health. The company underwrites Medicare Advantage HMO and HMO-POS plans, Individual and Family health plans (including Qualified Health Plans through the insurance marketplace), and employer group products across fully-insured and self-funded structures, with coverage extending across 25 northern Ohio counties. It sells two $0 premium MAPD plans — Topaz (HMO) and Quartz (HMO, launched for 2026) — and offers PPO products through SC*Premier*, SC*Select*, and SC*Connect* networks, plus ancillary dental, vision (VSP and EyeMed), pharmacy (MedImpact, Prime Therapeutics, Acaria Health), and wellness (WebMD Health Manager) lines.
SummaCare's revenue model rests on recurring monthly premiums from three customer segments: CMS and Medicare beneficiaries for Medicare Advantage, individual subscribers on the marketplace and direct, and employer-paid premiums for group plans. Distribution spans direct-to-consumer (website, Medicare sales events, Plan Central member portal), licensed insurance brokers across all product lines, and direct field sales to Ohio employers of all sizes. The company combines a 4.5-star (out of 5) CMS Medicare Advantage rating for 2026 and an NCQA accreditation held since 2001, paired with reported 97% year-over-year MA member retention.
The technology stack is predominantly third-party assembled rather than proprietary. Member-facing infrastructure centers on the Plan Central web portal for eligibility, claims, EOBs, and benefits management. Provider workflows run through the GuidingCare authorization portal integrated with EviCore for prior authorization on musculoskeletal, cardiovascular, radiology, oncology, and genomic services, with medical criteria drawn from CMS guidelines and InterQual standards (Change Healthcare). Compliance infrastructure includes a CMS Patient Access API managed in partnership with SS&C Health. No proprietary AI/ML capabilities, patents, or research are evidenced in the available sources; the technology profile is one of integration rather than innovation. In 2024, Summa Health's Board of Directors approved a strategic partnership with Health Assurance Transformation Corporation (HATCo), indicating a potential ownership or strategic restructuring at the parent level that could materially affect SummaCare's operating posture.
SummaCare firmographics
Firmographics- Name
- SummaCare
- Legal name
- SummaCare, Inc.
- Website
- https://summacare.com
- Company type
- Private
- Founded year
- 1993
- Operating status
- Operating
- Headcount range
- 251–500 employees
- Short description
- SummaCare is an Ohio-based, for-profit health insurance company founded in 1993 that underwrites Medicare Advantage HMO/HMO-POS plans, Individual and Family plans, and employer group PPO products across 25 northern Ohio counties, distributing through direct sales, brokers, and the federal marketplace with 4.5-star CMS ratings.
- Ownership category
- akta.pro rank
SummaCare industry classification
Industry- Product category
- Health Insurance
- NAICS
- Direct Life, Health, and Medical Insurance Carriers (52411), HMO Medical Centers (621491)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Medicare Advantage HMOs (HMO/HMO-POS) (HLAEAMAH)
- akta.pro secondary industries
- Group HMO Plans (FSAIAFAK), MA HMO Plans (HLAEACAA)
Keywords
Where SummaCare is headquartered
LocationHeadquarters
- HQ city
- Akron
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
SummaCare business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Operations, Personnel, Technology or R&D, Marketing or Sales, Others
Revenue model
- Medicare Advantage Plans: HMO and HMO-POS Medicare Advantage plans with Medicare contract. Revenue generated through premiums from CMS and Medicare beneficiaries. Coverage includes medical, pharmacy, dental, vision, and additional benefits.
- Individual & Family Plans: Health insurance plans for individuals and families under 65, including Qualified Health Plans through the insurance marketplace. Revenue through monthly premiums.
- Employer Group Products: Fully-insured and self-funded group health insurance plans for employers of all sizes. Revenue through employer-paid premiums based on employee count and plan selection.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Monthly | $0 Premium Medicare Advantage Plans |
| Subscription | Monthly | Individual & Family Plans |
| Subscription | Monthly | Employer Group Plans |
Go-to-market motion3 records
Distribution channels4 records
Marketing channels6 records
SummaCare product offering
Product offeringCore offering
SummaCare is a regional Ohio health insurance company that sells Medicare Advantage HMO and HMO-POS plans (including $0-premium Topaz and Quartz MAPD plans), Individual & Family Qualified Health Plans (marketplace metal tiers), and Employer Group PPO products (fully-insured and self-funded) under a Medicare contract. The company manages member services through its Plan Central portal and coordinates prior authorization and utilization management through GuidingCare, EviCore, and InterQual-based workflows, with CMS-rated 4.5-star quality and NCQA accreditation since 2001.
Product overview
SummaCare is a regional health insurance provider in Ohio offering Medicare Advantage plans (HMO and HMO-POS) and Individual & Family plans, along with Employer Group Products (PPO). The company operates primarily through its Plan Central member portal and provider-facing systems. Medicare Advantage offerings include $0 premium HMO plans (Topaz and Quartz), with coverage across 25 northern Ohio counties. Employer products include SC*Premier* PPO, SC*Select* PPO, and SC*Connect* PPO network options. The company also provides integrated pharmacy benefits through MedImpact and Prime Therapeutics, vision benefits through VSP and EyeMed, and dental benefits through Dental Care Plus Group. Provider tools include GuidingCare authorization portal, Plan Central for claims and eligibility, and EviCore for prior authorization of musculoskeletal and cardiovascular services.
Differentiator
Problem solved
Functional benefit
Products and services
- Medicare Advantage Plans (HMO and HMO-POS) Medicare contract-based Medicare Advantage health plans (HMO and HMO-POS) for Medicare-eligible beneficiaries across 25 northern Ohio counties, providing medical, pharmacy, and supplemental benefits including dental, vision, hearing, and wellness programs.
- Topaz (HMO) Medicare Advantage Plan SummaCare's $0 premium HMO Medicare Advantage plan offering comprehensive coverage with $0 medical copay and $0 copay on preventive dental, hearing, and vision exams across 25 northern Ohio counties.
- Quartz (HMO) Medicare Advantage Plan New for 2026, SummaCare's second $0 premium HMO Medicare Advantage plan (MAPD), offering $0 premium, $0 medical copay, and $0 preventive dental/hearing/vision copays across 25 northern Ohio counties.
- Individual & Family Health Plans Health insurance plans for individuals and families under age 65, offered as Qualified Health Plans on the marketplace in metal tiers (Bronze, Silver, Gold) with comprehensive medical and pharmacy coverage and budget-friendly options.
- Employer Group Products (PPO) Group health insurance products for Ohio employers of all sizes, including fully-insured PPO, self-funded options, MEWA plans, plus bundled pharmacy, dental, and vision benefits; offered through SC*Premier* PPO, SC*Select* PPO, and SC*Connect* PPO network configurations.
Quantifiable outcome
- 97% year-over-year retention rate among Medicare Advantage members
- +2 more outcomes
Companies that use SummaCare
Customer profileNamed customers3 records
Segments4 records
Ideal customer profiles3 records
SummaCare technology and API
TechnologyTechnology focussed No
API detail
- Has API
- Yes
- API docs
- API detail
Core technology
AI maturity
App detail
Integration16 records
Feature4 records
SummaCare partnerships and signals
Strategic signalPartnerships
Nine partnerships are on record, tiered core.
- Health Assurance Transformation Corporation (HATCo)coreSumma Health's Board of Directors approved strategic partnership with Health Assurance Transformation Corporation (HATCo) to transform the future of healthcare. This is a significant strategic alignment for the SummaCare parent organization.
- SS&C HealthcoreSS&C Health manages the secure Patient Access API enabling SummaCare Medicare and Marketplace members to access and download their health records to third-party apps of their choice, in compliance with CMS Interoperability and Patient Access Rule.
- VSP Vision CarecoreVSP provides vision coverage including standalone vision plans available to SummaCare members and non-members. Pediatric vision benefits for children up to age 19 included in small group and individual plans through VSP.
- eviCore HealthcarecoreeviCore Healthcare handles prior authorization for Musculoskeletal (MSK) and Cardiovascular CPT codes, high-tech radiology, radiation oncology, medical oncology, and molecular genomic laboratory services.
- Prime TherapeuticscorePrime Therapeutics manages medical pharmacy partnership for SummaCare, providing specialty pharmacy services and drug management.
- Acaria HealthcoreAcaria Health provides Medicare specialty pharmacy services for SummaCare members requiring specialty medications.
- WebMDcoreWebMD Health Manager provides online wellness tools including Health Risk Appraisal, employee wellness platform, challenges, messaging, reporting, Digital Health Assistant and tracking tools for SummaCare employer members.
- Dental Care Plus Group (DCPG)coreDCPG offers dental benefit plans including DentaTrust, DentaSpan, and DentaSelect Plus for Ohio employers through SummaCare.
- Change HealthcarecoreChange Healthcare provides InterQual criteria tools including Imaging Guidelines, Behavioral Health Guidelines, Adult and Pediatric Procedures Criteria, Level of Care Criteria, DME Criteria, Home Care Criteria, and Medicare Procedures Criteria for utilization management decisions.
Scale indicators5 records
Recent moves7 records
Expansion highlights5 records
SummaCare competitors and assessment
Company assessmentDirect peers
- Medical Mutual of Ohio: Cleveland-based regional health insurer offering Medicare Advantage, individual, and employer group plans across Ohio. Directly comparable as a regional Ohio-based carrier competing in the same northern Ohio counties and product segments as SummaCare.
- Paramount Health Plans (ProMedica): Northwest Ohio-based regional health plan owned by ProMedica, offering Medicare Advantage, individual, and employer group products. Competes with SummaCare in overlapping Ohio geographies with similar HMO/PPO plan structures.
- CareSource: Ohio-headquartered nonprofit managed care plan serving Medicare Advantage, Medicaid, and Marketplace members. Comparable as a regional Ohio payor with overlapping MA and individual product offerings and similar integrated-care orientation.
- AultCare: Canton, Ohio-based community health plan serving Northeast Ohio with Medicare Advantage, group, and individual products. Directly comparable as a regional Ohio-based carrier of similar size and product mix to SummaCare.
- MediGold: Ohio-based Medicare Advantage HMO plan affiliated with Mount Carmel Health System. Competes head-to-head with SummaCare for MA members in central and northern Ohio with a similar integrated payor-provider model.
- Buckeye Health Plan (Centene): Ohio Medicaid and Marketplace managed care plan owned by Centene. Comparable as an Ohio-licensed carrier selling government-sponsored health plans, though with heavier Medicaid weighting than SummaCare.
Broad incumbents
- Anthem Blue Cross and Blue Shield Ohio: Ohio's largest BCBS licensee offering Medicare Advantage, individual, and employer group plans statewide. Competes with SummaCare across all product lines but with vastly broader scale, network, and brand recognition.
- Humana: Nation's largest Medicare Advantage-focused carrier. Competes aggressively against SummaCare in Ohio MA with deeper broker commissions, broader networks, and superior national marketing scale.
- UnitedHealthcare (Medicare & Retirement): Largest U.S. health insurer with dominant Medicare Advantage market share. Competes with SummaCare across MA, individual, and employer lines in Ohio with substantially greater financial and network resources.
- Aetna (CVS Health): National health insurer and CVS Health subsidiary with growing Medicare Advantage footprint. Competes with SummaCare in Ohio MA and group segments with the backing of retail-clinic distribution and integrated PBM assets.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat5 records
Key risks6 records
Key highlights7 records
Customer concentration
SummaCare social profiles
Digital presenceSummaCare compliance and trust
Trust signalCompliance4 records
SummaCare financial estimates
Financial estimateRevenue estimate
Valuation estimate
SummaCare leadership team
Management profileNumber of profiles
Profiles1 record
SummaCare funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
SummaCare M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about SummaCare
What does SummaCare do?
SummaCare is a regional Ohio health insurance company that sells Medicare Advantage HMO and HMO-POS plans (including $0-premium Topaz and Quartz MAPD plans), Individual & Family Qualified Health Plans (marketplace metal tiers), and Employer Group PPO products (fully-insured and self-funded) under a Medicare contract. The company manages member services through its Plan Central portal and coordinates prior authorization and utilization management through GuidingCare, EviCore, and InterQual-based workflows, with CMS-rated 4.5-star quality and NCQA accreditation since 2001.
Is SummaCare a public or private company?
SummaCare is a private company. It is classified as corporate owned and is currently operating.
When was SummaCare founded?
SummaCare was founded in 1993. It employs 251 to 500 people.
Where is SummaCare based?
SummaCare is headquartered in Akron, United States, in the North America region.
How does SummaCare make money?
Three revenue lines are on record. Medicare Advantage Plans are the primary driver. The others are individual & Family Plans and employer Group Products.
Who are SummaCare's main competitors?
Direct peers on record are Medical Mutual of Ohio, Paramount Health Plans (ProMedica), CareSource, AultCare, MediGold and Buckeye Health Plan (Centene). Broad incumbents are Anthem Blue Cross and Blue Shield Ohio, Humana, UnitedHealthcare (Medicare & Retirement) and Aetna (CVS Health).
Does SummaCare have an API?
Yes. SummaCare offers a Patient Access API as required by the CMS Interoperability and Patient Access Rule. This API allows members to access and download their health record information through third-party apps of their choice. The API includes health insurance claims and clinical information submitted by healthcare providers. SS&C Health is the contracted company managing the secure data download. The ability to access and download health record information is not available to all SummaCare members, including those enrolled in off-Marketplace, Commercial Group or Self-Funded plans. Third-party apps are required to submit privacy and security practices for approval before gaining API access. Developer documentation is at fdp.edifecsfedcloud.com/#/portal/ss.c.health/home.
What industry is SummaCare in?
SummaCare's product category is Health Insurance. Its primary akta.pro industry code is HLAEAMAH, Medicare Advantage HMOs (HMO/HMO-POS), with a secondary code of FSAIAFAK, Group HMO Plans. Its NAICS code is 52411 and its SIC code is 6324.