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Valor Health Plan (HMO I-SNP) Costs & Coverage, Clark County, Ohio
Valor Health Plan (HMO I-SNP) Costs & Coverage, Clark County, Ohio
Discover how Valor Health Plan (HMO I-SNP) stands out as a 2025 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. Review this plan to understand how it aligns with your health and financial goals.
This Valor Health Plan HMO I-SNP plan is required to provide all of the same benefits as Original Medicare, but out-of-pocket costs are different. Available to qualified individual living in Clark County, OH, Valor Health Plan may include extra benefits not covered by Medicare Part A or Part B.
- Doctor Visits
- Foot Care
- Chiropractic
- Urgent & Emergency
- Mental Health
- Rehab Services
- Equipment & Supplies
- Diag, Lab, Imaging
- Part B Drugs
- Dental
- Hearing Aids
- Vision
- Prescriptions
Plan ID H1119-001-0 Overview | |
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Health Plan ID: | H1119-001-0 |
Medicare Advantage Plan Type: | HMO I-SNP |
Plan Year: | 2025 |
Monthly Premium: | $39.30 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | 9,350.00 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Basic, $590.00 deductible |
Supplemental Benefits: | None |
Availability: | Clark County, OH |
Insured By: | Valor Health Plan |
We're Here to Help You Enroll |
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Health Plan Cost Sharing & Benefits
Valor Health Plan is a Health Maintenance Organization (HMO) plan. As an HMO {plan_type_2} member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Valor Health Plan does cover out-of-network care for emergencies and out-of-area dialysis.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
Service | Enrollee Cost (in-network) |
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Primary: | 20% Coinsurance |
Specialist: | 20% Coinsurance |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
Service | Enrollee Cost |
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Emergency room care: | 20% Coinsurance |
Urgent care: | 20% Coinsurance |
Ground ambulance: | 20% Coinsurance |
Inpatient hospital care: | Coming Soon |
Skilled Nursing Facility: | Unknown |
This section covers Medicare-approved foot care services, including exams and routine foot care.
Service | Enrollee Cost (in-network) |
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Foot Exams and Treatments (Medicare-covered): | 20% Coinsurance |
Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
Service | Enrollee Cost (in-network) |
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Medicare-covered chiropractic: | 20% Coinsurance |
Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
Service | Enrollee Cost (in-network) |
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Outpatient individual therapy: | 20% Coinsurance |
Outpatient group therapy: | 20% Coinsurance |
Inpatient psychiatric hospital care: | Coming Soon |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
Service | Enrollee Cost (in-network) |
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Physical therapy and speech and language therapy: | 20% Coinsurance |
Occupational therapy: | 20% Coinsurance |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
Service | Enrollee Cost (in-network) |
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Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
Service | Enrollee Cost (in-network) |
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Diagnostic radiology services: | 20% Coinsurance |
Lab services: | 20% Coinsurance |
Outpatient x-rays: | 20% Coinsurance |
Diagnostic tests and procedures: | 20% Coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
Service | Enrollee Cost (in-network) |
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Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
Service | Member Cost (in-network) |
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Medicare Covered Preventive Dental | 20% Coinsurance |
Oral exam | |
Dental x-rays | |
Cleaning | |
Periodontics | |
Endodontics | |
Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
Service | Member Cost (in-network) |
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Fitting/evaluation | Not Covered |
Hearing aids | Not Covered |
Hearing exam | Not Covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
Service | Member Cost (in-network) |
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Medicare-covered eye exam (in-network) | 20% Coinsurance |
Routine eye exam (in-network) | Not Covered |
Eyewear benefits | None |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $39.30 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $39.30 |
Low Income Premium Subsidy: | $39.30 |
Low Income Premium Subsidy CMS Pays: | $39.30 |
Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before Valor Health Plan begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Valor Health Plan has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Retail | Mail Order | |
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Cost data not available. | |||
*Deductible does not apply. |
CMS 5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage {plan_type_2}s across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Valor Health Plan plan.
CMS Measure | Star Rating |
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2025 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | Not enough data available |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | Not enough data available |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | Not enough data available |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | Not enough data available |
Drug Safety and Accuracy of Drug Pricing |
Eligibility for Enrollment in Valor Health Plan
To enroll in Valor Health Plan , you must meet the following three criteria:
- You are eligible for Medicare;
- You reside within the plan’s service area; and
- You require the level of care typically provided in an institutional setting, such as a long-term care nursing facility, for 90 days or more.
This plan is for individuals living in a long-term care facility.
If you live at home and need a similar level of skilled care, you may qualify for an Institutional Equivalent Special Needs Plan (IE-SNP).
Important Enrollment Periods
Once you’ve confirmed your eligibility for Valor Health Plan , it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): The first time you can enroll in Medicare, typically around your 65th birthday.
- Annual Enrollment Period (AEP): Occurs yearly and allows you to make changes to your Medicare coverage.
- Special Enrollment Periods (SEPs): Special circumstances, such as moving or losing other coverage, may qualify you to enroll outside of the usual periods.
For comprehensive information on these enrollment periods, learn more here and make well-informed Medicare decisions.
Contact Valor Health Plan
Website: | Valor Health Plan Plan Page |
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Providers: | Valor Health Plan Providers Page |
Formulary: | Valor Health Plan Formulary Page |
Pharmacy: | Valor Health Plan Pharmacy Page |
New Member Health Plan Help: | (800)485-3793 |
New Member Health Plan TTY: | 711 |
New Member Part D Help: | (800)485-3793 |
New Member Part D TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
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