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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 2025, 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 SC Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $20.00. You must continue to pay paying your reduced 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 $12999.00 (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 $12999.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions, depending on the drug tier and pharmacy you use. For example, you'll pay an $8 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. In this phase, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Clover Health LiveHealthy (PPO) plan offers comprehensive coverage, including inpatient hospital stays with copays, outpatient services, and emergency services. It also provides coverage for primary care, preventive services, hearing, vision, and dental, often with copays. The plan also covers home health services and skilled nursing facilities with copays, along with various other services like home infusion and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $320 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered Stay and Additional Days for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $295 copay, observation services with a $350 copay, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services have a $15 copay for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial hospitalization is covered by the Clover Health LiveHealthy (PPO) plan, but requires prior authorization. You will have a $70 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clover Health LiveHealthy (PPO) plan. Ground and Air Ambulance Services have a $350 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $100 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage has a $100 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $350 copay.
Primary Care See details
The Clover Health LiveHealthy (PPO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services and occupational therapy have a $15 copay, physician specialist services have a $10 copay, and physical therapy and speech-language pathology services have a $15 copay. For individual and group sessions for mental health and psychiatric services, the copay is $15. Other health care professional services have a copay between $0 and $10, and additional telehealth benefits have a copay between $0 and $10. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services. This plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams with a $10 copay per visit, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a $10 copay, as well as coverage for contact lenses and eyeglasses (lenses and frames) with a combined maximum of $200 per year. Eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a $10 copay. Other dental services, including oral exams, dental x-rays, and cleaning, are covered with a $1,000 annual maximum benefit, and a $20 copay applies to restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, and oral and maxillofacial surgery. Prosthodontics, removable has a 50% coinsurance, while orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Clover Health LiveHealthy (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Clover Health LiveHealthy (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Clover Health LiveHealthy (PPO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for Medicare-covered Diagnostic Procedures/Tests and Medicare-covered Lab Services. Diagnostic Procedures/Tests have a maximum copay of $175, and Lab Services have no copay. Radiological Services require a copay for Medicare-covered Diagnostic and Therapeutic Radiological Services, and a 20% coinsurance for Therapeutic Radiological Services. Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered under the Clover Health LiveHealthy (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Clover Health LiveHealthy (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clover Health LiveHealthy (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203 per day; additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services offered by the Clover Health LiveHealthy (PPO) plan include Over-the-Counter (OTC) items with a maximum benefit of $75.00 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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