Samaritan Advantage Valor (HMO) 2025 Plan Details for Lincoln County, Oregon Residents
Samaritan Advantage Valor (HMO) 2025 Plan Details for Lincoln County, Oregon Residents
When selecting a Medicare Advantage plan in Lincoln County for 2025, it's important to compare all your options. Samaritan Advantage Valor (HMO) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
As of May 31, 2025, plan enrollments topped 258 members, with 158 in Lincoln County, Oregon.
Samaritan Advantage Valor Overview
| Plan ID H3811-001-0 Overview | |
|---|---|
| Health Plan ID: | H3811-001-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2025 |
| Monthly Premium: | $9.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $6,000.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Lincoln County, OR |
| Insured By: | Samaritan Advantage Health Plans |
Explore the Benefits of Samaritan Advantage Valor
Samaritan Advantage Valor is a Medicare Advantage HMO plan designed to keep your care simple and cost-effective. With a monthly premium of $9.00, it covers all core Medicare Part A and Part B benefits while encouraging you to choose a primary care provider and stay within the plan’s network. This coordinated approach helps you stay organized and manage expenses with confidence.
Primary care visits have a $25 copay, specialist visits come with a $50 copay, lab services cost $10 copay, urgent care services carry a $35 copay, and ambulance transportation is $375 copay. These expenses apply toward your maximum out-of-pocket (MOOP) limit of $6,000.00 . After reaching that amount, your in-network care is fully covered for the rest of the year — making this plan a dependable option for people who value structure, predictability, and cost control.
This plan is listed by CMS as H3811-001-0. You’ll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
| We're Here to Help You Enroll |
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Cost-Sharing Overview
Samaritan Advantage Valor includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H3811-001-0.
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) |
|---|---|
| Primary: | $25 Copay |
| Specialist: | $50 Copay Prior Authorization Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $35 Copay |
| Ground ambulance: | $375 Copay |
| Inpatient hospital care: | $375.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
| Skilled Nursing Facility: | $10.00 per day for days 1 through 20 $214.00 per day for days 21 through 45 $0.00 per day for days 46 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $35 Copay |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay |
| 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) |
|---|---|
| Outpatient individual therapy: | $20 Copay |
| Outpatient group therapy: | $20 Copay |
| Inpatient psychiatric hospital care: | $1,500.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $30 Copay |
| Occupational therapy: | $30 Copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| 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) |
|---|---|
| Diagnostic radiology services: | 20% Coinsurance Prior Authorization Required |
| Lab services: | $10 Copay Prior Authorization Required |
| Outpatient x-rays: | $15 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $10 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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) |
|---|---|
| Medicare Covered Preventive Dental | $20 Copay Prior Authorization Required |
| Oral exam | $0 |
| Dental x-rays | $0 |
| Cleaning | $0 |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Not Covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $40 Copay |
| Routine eye exam (in-network) | $ to $20 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $500.00 Every year |
Certain preventive services are covered 100% by Samaritan Advantage Valor as a Part B benefit.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Overview
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for Samaritan Advantage Valor
To qualify for enrollment in Samaritan Advantage Valor , you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Samaritan Advantage Valor and enjoy the extensive healthcare benefits it offers.
When Should You Enroll in Samaritan Advantage Valor ?
Knowing when you can enroll in Samaritan Advantage Valor is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
Steps to Enroll in Samaritan Advantage Valor
Enrolling in Samaritan Advantage Valor is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Samaritan Advantage Valor through the official Medicare website.
- Directly with Samaritan Advantage Valor : You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H3811-001-0:
What’s the monthly premium for Samaritan Advantage Valor (HMO)?
The 2025 premium is $9.00 each month, and you must continue to pay your Part B premium.
What’s the MOOP for Samaritan Advantage Valor in 2025?
For 2025, the maximum you’d spend out-of-pocket in-network is $6,000.00 .
How is this plan rated by Medicare?
The latest CMS score is ★3.0 out of 5 stars; anything 4 or higher earns quality bonuses.
How many members does Samaritan Advantage Valor have?
As of last month, about 258 beneficiaries are enrolled.
Contact Samaritan Advantage Health Plans
| Website: | Samaritan Advantage Health Plans Plan Page |
|---|---|
| Providers: | Samaritan Advantage Health Plans Providers Page |
| New Member Health Plan Help: | (800)207-3182 |
| New Member Health Plan TTY: | (800)735-2900 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Samaritan Advantage Health Plans, http://www.samhealthplans.org/shop-samaritan-plans/medica, Last Accessed June 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage", Last Accessed 25 May, 2025
- Medicare.gov, "Your coverage options", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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