A non-government entity
Samaritan Advantage Valor (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Samaritan Advantage Valor (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Samaritan Advantage Valor (HMO) in 2025, please refer to our full plan details page.
Samaritan Advantage Valor (HMO) is a HMO plan offered by Samaritan Health Services available for enrollment in 2025 to people living in Benton, Lincoln and Linn counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Samaritan Advantage Valor (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Samaritan Advantage Valor (HMO).
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 Samaritan Advantage Valor (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 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 Samaritan Advantage Valor (HMO)
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
Prescription drugs are not covered by Samaritan Advantage Valor (HMO).
Additional Benefits
The Samaritan Advantage Valor (HMO) plan offers a range of benefits, including inpatient hospital stays with copays, and outpatient services with varying copays or coinsurance. This plan covers primary care, preventive, hearing, vision, and dental services, with copays for exams and specific services. It also includes additional benefits like ambulance, emergency, and home health services, as well as medical equipment and diagnostic services with copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a $375 copay for days 1-5, and no copay for days 6-90, and Inpatient Hospital Psychiatric with a $1500 copay. Additional days, non-Medicare stays, and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $35 and $575, Observation Services have a $125 copay, and Ambulatory Surgical Center Services have a $400 copay. Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Samaritan Advantage Valor (HMO) plan, but requires prior authorization. The copay for this benefit is $50.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Samaritan Advantage Valor (HMO) plan. Ground Ambulance Services have a $375 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Samaritan Advantage Valor (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $35 copay; there is no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The Samaritan Advantage Valor (HMO) plan covers primary care physician services with a copay of $10-$25, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a copay of $35-$50. This plan also covers mental health specialty services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, and opioid treatment program services with a 20% coinsurance.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Additional preventive services include a fitness benefit with a copay between $10 and $50, as well as coverage for personal emergency response systems, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. Health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, as well as prescription and OTC hearing aids, each with a maximum benefit of $500 per year. Routine hearing exams have a copay of $30, and fitting/evaluation for hearing aids, as well as prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $40 copay, and routine eye exams with a $20 copay for one visit per year. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $500 per year for all eyewear upgrades.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $20 copay, and other dental services are also covered. Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Prosthodontics (fixed) are all covered. Orthodontics is not covered. There is a $500 maximum plan benefit per year.
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. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Samaritan Advantage Valor (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment and Prosthetics/Medical Supplies, are covered by the Samaritan Advantage Valor (HMO) plan. For Durable Medical Equipment, you pay 20% coinsurance with no copay, and for Prosthetics/Medical Supplies, you also pay 20% coinsurance with no copay. The plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures, lab services, and radiological services. Diagnostic procedures and lab services have a $10 copay, while outpatient X-ray services have a $15 copay, and diagnostic and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Samaritan Advantage Valor (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Samaritan Advantage Valor (HMO) plan, with prior authorization required. For days 1-20, there is a $10 copay, for days 21-45 there is a $214 copay, and for days 46-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, which has a $20 copay, and over-the-counter items with a maximum benefit coverage amount of $50 every three months. This plan does not cover 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, or Self-Directed Personal Assistance Services.
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