A non-government entity
Valor Health Plan (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Valor Health Plan (HMO I-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Valor Health Plan (HMO I-SNP) in 2026, please refer to our full plan details page.
Valor Health Plan (HMO I-SNP) is a HMO I-SNP plan offered by The Schroer Group, Inc. available for enrollment in 2025 to people living in Select Counties in Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Valor Health Plan (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Valor Health Plan (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Valor Health Plan (HMO I-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Valor Health Plan (HMO I-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.20. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Valor Health Plan (HMO I-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Valor Health Plan (HMO I-SNP) features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug coverage tier details, including individual copayments and coinsurance amounts, are currently unavailable for this plan. To fully understand your potential out-of-pocket expenses, it is recommended to contact the provider directly to verify how your specific prescriptions are covered.
Additional Benefits
The Valor Health Plan (HMO I-SNP) generally offers coverage with no copayments, instead utilizing a standard 20% coinsurance for most outpatient, emergency, primary care, and specialist services. This 20% coinsurance also applies to diagnostic services, dialysis, durable medical equipment, and Medicare-covered dental and vision care, though routine dental and vision services are excluded from coverage. For inpatient hospital stays, Medicare-defined coinsurance and cost-sharing apply rather than flat copays. Beneficiaries can access several services with no copay and no coinsurance, including home health services, skilled nursing facility care, and basic hearing exams. Additionally, the plan provides an over-the-counter item allowance of up to $194 every three months with no copay or coinsurance. Medicare Part B insulin drugs are a notable exception to the coinsurance-only model, requiring a $35 copay.
Inpatient Hospital See details
Inpatient hospital benefits under Valor Health Plan (HMO I-SNP) are partially covered, offering acute and psychiatric care with no copay, though Medicare-defined coinsurance and cost-sharing apply and prior authorization is required. Additional days, non-Medicare-covered stays, and acute upgrades are not covered under this benefit.
Outpatient Services See details
Valor Health Plan (HMO I-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered by Valor Health Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Ambulance and Transportation Services See details
Valor Health Plan (HMO I-SNP) covers Medicare-covered ground and air ambulance services with a 20% coinsurance and no copay, which is not waived upon hospital admission. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Valor Health Plan (HMO I-SNP) covers emergency and urgently needed services with a 20% coinsurance and no copay, while worldwide emergency services are not covered. Coinsurance is capped at $115 per visit for emergency services and $40 per visit for urgent care, with fees waived if you are admitted to the hospital within one or three days, respectively.
Primary Care See details
Valor Health Plan (HMO I-SNP) covers primary care, specialist visits, outpatient therapies, telehealth, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Some chiropractic services are covered but routine and other chiropractic care are not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under Valor Health Plan (HMO I-SNP), offering Medicare-covered zero-dollar preventive services with no copay. Covered services such as kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs require no copay but have a 20% coinsurance, while annual physical exams and additional benefits like fitness programs are not covered.
Hearing Services See details
Hearing services are partially covered by Valor Health Plan (HMO I-SNP), offering covered hearing exams with no copay, no coinsurance, and no deductible. Routine hearing exams, fitting and evaluations, OTC hearing aids, and all types of prescription hearing aids are not covered.
Vision Services See details
Vision Services are technically covered by the Valor Health Plan (HMO I-SNP) with no copay and a 20% coinsurance, but in practice, the benefit is not covered because routine eye exams, contact lenses, and eyeglasses are all excluded from coverage.
Dental Services See details
Valor Health Plan (HMO I-SNP) partially covers dental services, offering Medicare-covered dental benefits with no copay and 20% coinsurance. Other dental services, including preventive cleanings, oral exams, x-rays, fluoride, restorative care, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Valor Health Plan (HMO I-SNP) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, which counts toward the plan's deductible.
Dialysis Services See details
Dialysis Services are covered by Valor Health Plan (HMO I-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Valor Health Plan (HMO I-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
Valor Health Plan (HMO I-SNP) covers diagnostic and radiological services with no copay, requiring a 20% coinsurance for all covered diagnostic procedures, lab services, X-rays, and radiological services. Prior authorization is required for all covered radiological services.
Home Health Services See details
Home Health Services are covered by Valor Health Plan (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Valor Health Plan (HMO I-SNP) with no copay, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered in practice and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Valor Health Plan (HMO I-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, subject to prior authorization. The plan allows for SNF admission without requiring a prior three-day inpatient hospital stay, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Valor Health Plan (HMO I-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $194 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved