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Clover Health Choice Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health Choice Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clover Health Choice Value (PPO) in 2026, please refer to our full plan details page.
Clover Health Choice Value (PPO) is a PPO plan offered by Clover Health Holdings, Inc. available for enrollment in 2025 to people living in Select NJ Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Clover Health Choice Value (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Clover Health Choice Value (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Clover Health Choice Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $220.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Clover Health Choice Value (PPO) plan features an annual drug deductible of $220. Under this plan, Tier 1 preferred generic drugs have no copay for up to a three-month supply at standard pharmacies or through standard mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at standard pharmacies, with no copay for a three-month supply ordered via standard mail. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply at standard pharmacies, or a $135 copay for a three-month supply through retail or mail order. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs costing 35% coinsurance and Tier 5 specialty drugs costing 30% coinsurance.
Additional Benefits
The Clover Health Choice Value (PPO) plan offers affordable medical coverage featuring no copay and no coinsurance for primary care doctor visits, while specialist visits require a low $2 copay. For hospital care, members pay a $399 daily copay for the first six days of acute inpatient stays and a $250 copay for outpatient hospital services, both with no coinsurance. Emergency room visits have a $115 copay, which is waived if you are admitted to the hospital within 24 hours. In addition to core medical care, this plan provides excellent wellness benefits, including preventive dental care and routine eyewear up to a $200 annual limit with no copay. Routine hearing and vision exams are available for a low $2 copay, and members receive up to $170 every three months for over-the-counter items with no copay. Skilled nursing facility stays are also covered with no copay for the first 20 days.
Inpatient Hospital See details
Clover Health Choice Value (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $399 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $339 daily copay for days 1 to 6 and no copay for days 7 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Clover Health Choice Value (PPO) covers outpatient services with no coinsurance, featuring a $250 copay for outpatient hospital and observation services and a $175 copay for ambulatory surgical center services. Outpatient substance abuse services have no coinsurance with a $20 copay for individual sessions and a $10 copay for group sessions, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Clover Health Choice Value (PPO) plan with an $80.00 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Clover Health Choice Value (PPO), which features a $350 copay and no coinsurance for ground and air ambulance services, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Clover Health Choice Value (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $35 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered up to a $50,000 maximum benefit with no coinsurance, requiring copays of $115 for emergency care, $40 for urgent care, and $350 for emergency transportation.
Primary Care See details
Clover Health Choice Value (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $2 copay and no coinsurance. Chiropractic services are partially covered with a $5 copay and no coinsurance, excluding routine chiropractic care and other chiropractic services, while podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Clover Health Choice Value (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and various screenings. Additional preventive benefits are partially covered, offering memory fitness and remote access technologies, while services like health education, weight management, and in-home support are not covered.
Hearing Services See details
Clover Health Choice Value (PPO) partially covers hearing services, offering routine hearing exams for a $2.00 copay and no coinsurance, and up to two prescription hearing aids per year with a copay ranging from $499.00 to $999.00 and no coinsurance. While fitting and evaluation services are covered, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services under Clover Health Choice Value (PPO) are partially covered, offering one routine eye exam per year for a $2.00 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay and no coinsurance up to a $200 annual limit for one pair of contact lenses or eyeglasses, excluding individual eyeglass lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Clover Health Choice Value (PPO) up to an annual limit of $2,500, featuring no copay and no coinsurance for preventive services, while orthodontics are not covered. Most comprehensive services require a $20 copay and no coinsurance, though removable prosthodontics require no copay and 50% coinsurance, and Medicare-covered dental has a $2 copay and no coinsurance.
Home Infusion bundled Services See details
Clover Health Choice Value (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Clover Health Choice Value (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Clover Health Choice Value (PPO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, both requiring prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Clover Health Choice Value (PPO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $175 copay. Covered radiological services include outpatient X-rays for a $15 copay, diagnostic radiology with a minimum $40 copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Clover Health Choice Value (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Clover Health Choice Value (PPO) with no coinsurance and a $5 copay, requiring prior authorization. However, only some services are covered in practice, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Clover Health Choice Value (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare limit are not covered.
Other Services See details
Clover Health Choice Value (PPO) partially covers Other Services, offering no copay and no coinsurance for Over-the-Counter (OTC) items up to a maximum reimbursement of $170 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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