Valor Health Plans

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2025 Valor Health Plan

Valor Health Plan HMO Special Needs Plan with Prescription Drug for Institutional Residents (2025)

Valor Health Plan (HMO-SNP) is a Medicare Advantage health plan designed specifically for Medicare beneficiaries that reside in a long-term care facility. Valor Health Plan is headquartered in Northeast Ohio and available in select Ohio CMS-approved counties.

The Valor Advantage

  • Low Cost Premium $39.30 premium for medical coverage
  • Physical, Occupational and Speech Therapy No annual limit
  • Skilled Nursing Care No prior hospital stay requirement
  • All-In-One Plan Covers original Medicare benefits plus Medicare Part D prescription drugs
  • Over-the-Counter (OTC) Benefit $146 per quarter OTC benefit
  • Local Care Team Hands-on RNs and Nurse Practitioners to assist with quality care coordination

Summary of Important Costs
Monthly Premium $39.30
Primary Care Visit 20% per visit
Specialist Visit 20% per visit
Inpatient Hospital Stays $1,632 deductible for days 1 – 60
$408 copay per day for days 61 – 90
$816 copay per lifetime reserve day
These are 2024 cost sharing amounts and may change for 2025. Valor Health Plan will provide updated rates as soon as they are released.
Part D Prescription Drugs Standard Benefit
Deductible Stage: $590
Initial Coverage Stage: Coinsurance 25%
You pay up to $35 per month supply of each covered insulin product on this tier.
Catastrophic Coverage: During this payment stage, the plan pays the full cost for your covered Part D drugs. You pay nothing.
Maximum out-of-pocket
(for medical services) 		$9,350

Last Updated October 14, 2024

Enrollment Process

Enroll in a Medicare Advantage Special Needs Plan that’s right for you. Our dedicated licensed agents are here to guide you through the enrollment process. Simply call 1-800-485-3793 and set up an appointment to begin the enrollment process.

Valor Health Plan also accepts enrollment forms by fax or mail.

Once we confirm your eligibility with Medicare, you can expect to receive a confirmation letter by mail, identification card and your new member mailing within 10 days.

Call Member Services (available 8am – 8pm) at 1-800-485-3793.

Download Enrollment Form

Last Updated October 01, 2024

Formulary

Online Prior Authorization
Comprehensive Formulary – Last Updated 10/01/2024
Redetermination Request Form
Coverage Determination Request Form
Online Formulary Search Tool

Other Resources

Pharmacy Search
Medication Transition Policy
Medication Therapy Management
Safe Disposal

Last Updated October 01, 2024

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