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Clover Health LiveHealthy (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health LiveHealthy (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clover Health LiveHealthy (PPO) in 2026, please refer to our full plan details page.
Clover Health LiveHealthy (PPO) is a PPO plan offered by Clover Health Holdings, Inc. available for enrollment in 2025 to people living in Select Georgia Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Clover Health LiveHealthy (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 LiveHealthy (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 LiveHealthy (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (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 $10100.00 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:
Sign up for Clover Health LiveHealthy (PPO)
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Drug Coverage
The Clover Health LiveHealthy (PPO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, Tier 1 preferred generic drugs have no copay at standard pharmacies or through standard 3-month mail orders. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays starting at $8 for a 1-month supply and no copay for a 3-month standard mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at a standard pharmacy, while Tier 4 non-preferred drugs require a $100 copay. Standard 3-month mail orders for Tier 3 and Tier 4 cost $135 and $300 respectively. Specialty medications in Tier 5 require a 33% coinsurance for both standard pharmacy and standard mail order options.
Additional Benefits
The Clover Health LiveHealthy (PPO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care doctor visits and annual preventive exams. Specialist visits require a low $10 copay, while emergency room services carry a $115 copay that is waived if you are admitted. For hospital stays, members pay a $310 daily copay for the first six days of inpatient care and no copay for days 7 through 90. This plan also includes valuable everyday health benefits, such as dental coverage up to a $1,500 annual limit with no copay for preventive care and a $20 copay for most comprehensive services. Routine vision and hearing exams are available for a $10 copay, which includes a $300 annual eyewear allowance and affordable copays for prescription hearing aids. Additionally, members receive home health services with no copay and an over-the-counter reimbursement benefit of up to $80 every three months.
Inpatient Hospital See details
Clover Health LiveHealthy (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $310 daily copay for days 1 to 6 and no copay for days 7 to 90. Prior authorization is required, and while unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Clover Health LiveHealthy (PPO) covers outpatient hospital and observation services with a $375 copay and no coinsurance, while ambulatory surgical center services require a $275 copay and no coinsurance. Outpatient substance abuse services have no coinsurance with a $25 copay for individual sessions and a $15 copay for group sessions, and outpatient blood services are fully covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under Clover Health LiveHealthy (PPO) with a $70.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Clover Health LiveHealthy (PPO) covers ground and air ambulance services with a $350 copay per service, no coinsurance, and required prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Clover Health LiveHealthy (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency services are also covered up to a $50,000 maximum lifetime limit with no coinsurance, featuring copays of $115 for emergency coverage, $40 for urgent care, and $350 for emergency transportation.
Primary Care See details
Clover Health LiveHealthy (PPO) offers primary care doctor visits with no copay and no coinsurance, while specialist visits require a $10 copay and no coinsurance. Mental health, therapy, and telehealth services are also covered with copays ranging from $0 to $25 and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by Clover Health LiveHealthy (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings. Additional preventive benefits are partially covered, with memory fitness and remote access technologies included, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services covered by Clover Health LiveHealthy (PPO) include one annual routine exam for a $10 copay and no coinsurance, alongside unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $499 to $999 for up to two devices per year, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Clover Health LiveHealthy (PPO), offering one routine eye exam per year with a $10 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible up to a $300 annual limit for one pair of contacts or complete eyeglasses, though separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Clover Health LiveHealthy (PPO) offers partially covered dental services up to a $1,500 annual limit, though orthodontics is not covered. Preventive care has no copay and no coinsurance, Medicare-covered services require a $10 copay and no coinsurance, and comprehensive services generally cost a $20 copay and no coinsurance, except for removable prosthodontics which has no copay and 50% coinsurance.
Home Infusion bundled Services See details
Clover Health LiveHealthy (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin features a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are subject to a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Clover Health LiveHealthy (PPO) plan with no copay and a 20% coinsurance. This benefit ensures you have access to necessary dialysis treatments with clear, predictable out-of-pocket costs.
Medical Equipment See details
Clover Health LiveHealthy (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, though prior authorization is required. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Clover Health LiveHealthy (PPO) and require prior authorization. Members pay no copay or coinsurance for lab services, a $0 to $200 copay with no coinsurance for diagnostic procedures, a $20 copay for X-rays, a minimum $50 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by Clover Health LiveHealthy (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Clover Health LiveHealthy (PPO) with prior authorization and no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice and carry a $15 copay.
Skilled Nursing Facility (SNF) See details
Clover Health LiveHealthy (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a 3-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Clover Health LiveHealthy (PPO), featuring an over-the-counter (OTC) benefit with no copay and no coinsurance up to $80 every three months via reimbursement. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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