Clover Medicare Review

Clover Medicare Ratings at a Glance

Clover Health is a private insurance company specializing in Medicare Advantage plans. The company was founded in 2014 by Kris Gale and Vivek Garipalli. As of January, the company reports it has 82,000 members. Clover Health offers Medicare Advantage plans in 209 counties in nine states. Clover Health is a subsidiary of Clover Health Investments, Corp.

Clover Health specializes in two types of Medicare Advantage plans: the Clover Health HMO and the Clover Health PPO. To get the details of any plan, it must be available in your area. For research purposes, Benzinga used the ZIP code for Hudson County, home of Clover Health. 

Clover Health HMO

Two HMO plans come up: Clover Health Classic and Clover Health Value. 

Clover Health Classic

For Clover Health Classic, there is no additional monthly premium to your existing Medicare Part B payments. As long as you continue to pay your Part B premium, your Medicare Advantage plan is free. Other aspects of the plan include:

• Medical deductible: None
• Prescription drug deductible: $150
• Hospitalization (in network): $370 copay, days 1-6 /  $0, days 7-365
• Doctor’s visits (in-network): $0 copay, primary care physician (PCP) / $25 for specialists
• Emergency care: $95 copay per visit

Also included in the plan:

• Diagnostic services (labs, imaging)
• Hearing services
• Dental
• Vision
• Mental health
• Skilled-nursing facility
• Physical therapy
• Ambulance
• Foot care
• Prosthetic devices

Clover Health Value

For Clover Health Value, there is an additional $35 charge on top of your Plan B premiums, but you’ll find the copays are lower. If you plan on using your insurance more, the value plan is for you. Aspects of the plan include:

• Medical deductible: None
• Prescription drug deductible: $505
• Hospitalization (in-network): $340 copay, days 1-6 /  $0, days 7-365
• Doctor’s visits (in-network): $0 copay, PCP / $10 for specialists
• Emergency care: $95 copay per visit

Also included in the plan:

• Diagnostic services (labs, imaging)
• Hearing services
• Dental
• Vision
• Mental health
• Skilled-nursing facility
• Physical therapy
• Ambulance
• Foot care
• Prosthetic devices

Clover Health PPO

Two PPO plans come up: Clover Health Premier and Clover Health Premier Value.

Clover Health Premier

For Clover Health Premier, there is no additional monthly premium to your existing Medicare Part B payments. As long as you continue to pay your Part B premium, your Medicare Advantage plan is free. Other aspects of the plan include:

• Medical deductible: None
• Prescription drug deductible: $300
• Hospitalization (in network): $390 copay, days 1-5 /  $0, days 6-365
• Doctor’s visits (in network): $0 copay, PCP / $35 for specialists
• Emergency care: $95 copay per visit

Also included in the plan:

• Diagnostic services (labs, imaging)
• Hearing services
• Dental
• Vision
• Mental health
• Skilled-nursing facility
• Physical therapy
• Ambulance
• Foot care
• Prosthetic devices

Clover Health Premier Value

For Clover Health Premier, there is an additional $35 charge on top of your Plan B premiums, but you’ll find the copays are lower. If you plan on using your insurance more, the value plan is for you. Aspects of the plan include:

• Medical deductible: None
• Prescription drug deductible: $480
• Hospitalization (in network): $340 copay, days 1-4 /  $0, days 5-365
• Doctor’s visits (in network): $0 copay, PCP / $5 for specialists
• Emergency care: $95 copay per visit

Also included in the plan:

• Diagnostic services (labs, imaging)
• Hearing services
• Dental
• Vision
• Mental health
• Skilled-nursing facility
• Physical therapy
• Ambulance
• Foot care
• Prosthetic devices

Clover LiveHealthy Rewards Program®

Clover Health believes in preventative care. In fact, it believes in it so much, it puts its money where its mouth is. With the Clover LiveHealthy Rewards Program®, customers can now earn cash rewards.

New for 2023, when you enroll in a Clover Health Medicare Advantage plan, you also get a LiveHealthy Flex Plus Visa card. For every healthy task you complete in the program, you receive reward dollars on the card. Rewards include:

1. Get $100 without even leaving your chair: It doesn’t get any easier than this. To get your initial $100 credit, all you have to do is fill out the company’s getting-to-know-you form. It’s all just basic information, like your phone, email, doctors’ names and other simple stuff.
2. Get up to $100 for watching videos: Earn $100 just for watching the LiveHealthy learning videos teaching you how to access your benefits and manage your health.
3. Get $150 for a LiveHealthy Visit: Have a Clover Health-preferred doctor look at your lifestyle and medications. That’s all, and you’re $150 richer.
4. Get up to $60 for vaccines: Get $60 for getting your vaccines like the flu or any others. (Max two vaccines per year)
5. Get $120 to $180 per year for over-the-counter (OTC) items: Get $30 to $45 to apply toward your over-the-counter medications like pain relievers, vitamins and more. (four times per year)

Why Choose Clover Medicare?

Clover Health’s Medicare Advantage plans offer everything original Medicare does and more. Clover offers access to an even better prescription medication plan (Medicare Part D), than Medicare. When it comes to monthly premiums and other expenses like copays and out-of-pocket expenses, Clover is a cut above other Medicare Advantage plans.

When it comes to customer service, there’s really nothing spectacular about Clover Health. Just the basics. Sometimes, however, the basics are all you need. If you’re looking for a Medicare Advantage plan, all you have to do is call the Clover Health 1-800 number, any time between 8 a.m. and 8 p.m, seven days a week. A Clover Health specialist will take it from there. 

Or, you can get in touch via the contact page on the company’s website. Because Clover only operates in 11 states, it’s probably best you check to see whether your area is covered before you spend more time on it. The Clover Find a Plan page allows you to find out immediately whether the company sells policies in your area. Just type in your ZIP code, year for the policy and the website will tell you whether or not the company offers coverage in your area. If so, sample quotes and specific policy coverage will come up.

When you first look at customer pricing, you might think it’s all too good to be true. HMO and PPO plans as low as $0 per month? While it is indeed true, purchasing a Clover Medicare Advantage policy sometimes means just continuing to pay your existing Medicare Part B coverage with no extra charge from Clover. Other policies are available for as little as $35 more per month.

When it comes to user benefits, the Clover website spells out everything you need to know in painstaking detail. Just start at the Find a Plan page. Type in your ZIP code to see which plans are available in your area, if any. Once you choose a plan, either HMO or PPO, Clover lays out all the costs and benefits of the plan in multipage PDF documents. Everything you need about potential plans is right there for you to see: monthly premiums, deductibles, out-of-pocket expenses, in- and out-patient hospital costs, doctor’s visits and so on.

For members, the amount of information is extensive. See what drugs are covered, plan documents, find a provider or pharmacy. There’s even a COVID-19 FAQ page. Information also is available for providers and brokers.

Perusing the Clover Health website is as easy as it is informative. Shopping plans is as easy as inputting your ZIP code. For providers, Clover Health makes available all the tools they’ll need: authorization tools, claims, resources and support. It’s all right there at your fingertips.

Clover Medicare vs Competitors

When compared to the competition, Clover Health offers price breaks and services the others often don’t. For example:

• Requires no additional monthly premiums for many added benefits
• No out-of-pocket expenses like $0 copays and deductibles when seeing your PCP
• Same copays for doctors both in and out of network
• No required referral for specialists 
• $0 deductible for generic drugs

A Clover Medicare Advantage PPO is truly an open PPO. Just like with original Medicare, Clover allows you to see any doctor that accepts Medicare, nationwide, with no difference in cost. Out-of-network expenses are often the same low price as in-network.

Overall, Clover Health rates 4.5 out of 5 stars. The only thing the company website is lacking is a live chat. As far as pricing, customer service and how informative the website is, the company gets perfect scores. Clover Health is not only affordable, it’s comprehensive. Clover Health is one of the best companies to come along in a while.

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