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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 2025, 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 4.5 out of 5 stars in 2025.
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 $39.30. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 $9350.00 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:
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Drug Coverage
The Valor Health Plan (HMO I-SNP) has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs. Once your total drug costs reach $2000, you enter the Catastrophic Coverage Phase, where you pay nothing for Part D covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Valor Health Plan (HMO I-SNP) offers coverage for a range of services, including inpatient and outpatient care, with varying coinsurance amounts, such as 20% for outpatient services and primary care. Emergency and ambulance services are covered with no copay, but you may have to pay up to 20% coinsurance. Additional benefits include home health services with no copay, along with coverage for medical equipment and diagnostic services. Other benefits include coverage for dental, vision, and hearing services, but they may have limitations. The plan offers a quarterly allowance for over-the-counter items. However, it's important to note that some services like cardiac rehabilitation and certain dental, vision, and hearing services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, with a 20% coinsurance for Outpatient Hospital Services and Observation Services. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a coinsurance between 20% and 20%. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Valor Health Plan (HMO I-SNP), with a 20% coinsurance.
Ambulance and Transportation Services See details
The Valor Health Plan (HMO I-SNP) covers ambulance services with no copay and a 20% coinsurance for both ground and air ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with no copay and a 20% coinsurance, though the coinsurance is waived if admitted to the hospital within 1 day. Urgently Needed Services are covered with no copay and a 20% coinsurance, and the coinsurance is waived if admitted to the hospital within 3 days. Worldwide Emergency Services are not covered.
Primary Care See details
Valor Health Plan (HMO I-SNP) covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance. Chiropractic Services have a 20% coinsurance, but routine care is not covered. Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by the Valor Health Plan (HMO I-SNP). Medicare-covered preventive services are covered, while annual physical exams are not covered. Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance. Other services such as Health Education, In-Home Safety Assessment, and Personal Emergency Response System (PERS) are not covered.
Hearing Services See details
Hearing Services under the Valor Health Plan (HMO I-SNP) are partially covered, but specific services such as Routine Hearing Exams, Fitting/Evaluation for Hearing Aid, all types of Prescription Hearing Aids, and OTC Hearing Aids are not covered. Hearing Exams have a coinsurance of at most 20%.
Vision Services See details
Vision services are covered under the Valor Health Plan (HMO I-SNP), with a 20% coinsurance for eye exams and eyewear. However, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Valor Health Plan (HMO I-SNP). Medicare Dental Services are covered with 20% coinsurance, while Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Valor Health Plan (HMO I-SNP), with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and no copay. Prosthetics/Medical Supplies and Diabetic Equipment are also covered, with 20% coinsurance for some services and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Valor Health Plan (HMO I-SNP) with no copay, but you may have to pay up to 20% coinsurance for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. All Radiological Services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Valor Health Plan (HMO I-SNP) with no copay or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Valor Health Plan (HMO I-SNP). Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
Other Services for the Valor Health Plan (HMO I-SNP) covers Over-the-Counter (OTC) Items with a maximum benefit of $146 every three months, while acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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