Valor Health Plans

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2026 Valor Health Plan

Valor Health Plan HMO Special Needs Plan with Prescription Drug for Institutional Residents (2026)

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 $31.38 premium for medical coverage
  • Physical, Occupational and Speech Therapy No annual limit (based on Medical Necessity)
  • 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 $194 per quarter OTC benefit
  • Local Care Team Hands-on Nurses and Nurse Practitioners to assist with quality care coordination

Summary of Important Costs
Monthly Premium $31.38
Primary Care Visit 20% per visit
Specialist Visit 20% per visit
Inpatient Hospital Stays $1,676 deductible for days 1 – 60
$419 copay per day for days 61 – 90
$838 copay per lifetime reserve day

These are 2025 cost sharing amounts and may change for 2026. Valor Health Plan will provide updated rates as soon as they are released.

Part D Prescription Drugs Standard Benefit
Deductible Stage: $615
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 Part D: $2,100
Part C Medical Services
Maximum out-of-pocket
(for medical services)		 $9,250

Last Updated October 02, 2025

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, 2025

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