Valor Health Plan (HMO I-SNP) H1119-001 • 2027 • Seneca County, OH
- Monthly Premium
- $21.10Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Basic, $700.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Seneca County, OH
- Local Enrollment
- 14 beneficiaries in Seneca County
Introduction
Valor Health Plan is a Medicare Advantage Institutional Special Needs Plan (I-SNP) offered by Valor Health Plan. The plan uses a Health Maintenance Organization (HMO) provider network and includes Medicare Part D prescription drug coverage. For the 2027 plan year, it has a $21.10 monthly premium, $0.00 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H1119-001 identifies this plan. The 2027 Part D prescription drug deductible is $700.00.
You must live in Seneca County, Ohio to enroll in this plan. CMS reports 14 beneficiaries enrolled in this plan in Seneca County. For assistance with this plan, new members can call (800)485-3793 (TTY 711).
Eligibility
- Special Needs Plan Type
- Institutional Special Needs Plan (I-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals living in a long-term care facility.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Seneca County
Compare this plan with the most-enrolled other HMO I-SNP plan available in Seneca County, Ohio. Enrollment is based on CMS local enrollment data.
| Plan Detail | Valor Health Plan | Perennial Advantage Strive |
|---|---|---|
| CMS Plan ID | H1119-001-0 |
H8797-001-0 |
| Local Enrollment | 14 | 0 |
| Monthly Premium | $21.10 | $21.10 |
| Medical Deductible | Coming soon | Coming soon |
| Maximum Out-of-Pocket | $9,850.00 | $9,850.00 |
| Part B Giveback | Coming soon | Coming soon |
| Primary Care | Coming soon | Coming soon |
| Specialist | Coming soon | Coming soon |
| Part D Deductible | $700.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated |
| Dental | Coming soon | Coming soon |
| Vision | Coming soon | Coming soon |
| Hearing | Coming soon | Coming soon |
Plan Benefits
Valor Health Plan has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H1119-001.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H1119-001-0 Cost Compare.
Office Visits
- Primary care
- In-network: 20% coinsurance
- Specialist
- In-network: 20% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- Not covered
- Telehealth benefit
- In-network: 20% coinsurance
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 20% coinsurance
- Lab services
- In-network: 20% coinsurance
- Outpatient x-rays
- In-network: 20% coinsurance
- Diagnostic tests and procedures
- In-network: 20% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- 20% coinsurance
- Worldwide emergency care
- Coming soon
- Urgent care
- 20% coinsurance
- Inpatient hospital care
- Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150 - Skilled Nursing Facility
- $0 copay
- Ground ambulance
- In-network: 20% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 20% coinsurance
- Outpatient group therapy
- In-network: 20% coinsurance
- Inpatient psychiatric hospital care
- Tier 1
$0 per day for days 1-60
$434 per day for days 61-90
$868 per day for days 91-150
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: 20% coinsurance
- Occupational therapy
- In-network: 20% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 20% coinsurance
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- Not covered
- Dental x-rays
- Not covered
- Cleaning
- Not covered
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- Not covered
- Contact lenses
- Not covered
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- Not covered
- Fitting/evaluation
- Not covered
- Prescription hearing aids
- Not covered
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Valor Health Plan as a Part B benefit.
Prescription Drug Coverage
Valor Health Plan includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $21.10 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $21.10 |
| Low-Income Premium Subsidy: | $21.05 |
| Low-Income Premium Subsidy Paid by CMS: | $21.10 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $700.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Valor Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Valor Health Plan may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | 25% coinsurance |
| Generic drugs | 25% coinsurance | 25% coinsurance |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H1119)
CMS star ratings reflect how well a Medicare plan performs across key quality measures, such as managing chronic conditions, member satisfaction, and customer service. Ratings range from 1 to 5 stars and are updated each year by Medicare.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Valor Health Plan
- Website
- Valor Health Plan Plan Page
- 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
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Valor Health Plan (official source) | http://www.valorhealthplan.com | October 4, 2026 |
| CMS.gov | Institutional Special Needs Plans (I-SNPs) | April 28, 2026 |
| CMS.gov | Medicare Advantage Plan Fact Sheet | April 28, 2026 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | April 28, 2026 |
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