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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 SC 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. 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 $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 drug coverage begins immediately. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month, 2-month, or 3-month supply at standard pharmacies, as well as no copay for a 3-month standard mail order. Tier 2 generic drugs cost $8 for a 1-month supply at standard pharmacies, but you can save money with no copay for a 3-month supply filled via standard mail order. For higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies, while Tier 4 non-preferred drugs have a $100 copay for a 1-month supply. If you need Tier 5 specialty drugs, you will pay a 33% coinsurance for both standard pharmacy and standard mail order options. Choosing a 3-month standard mail order for Tier 3 and Tier 4 drugs caps your copayments at $135 and $300, respectively.
Additional Benefits
The Clover Health LiveHealthy (PPO) plan offers robust coverage for everyday medical needs, featuring no copay for primary care visits and a low $10 copay for specialists. Preventive care, home health services, and laboratory tests are also covered with no copay or coinsurance. For emergency and acute care, the plan features a $115 emergency room copay and a $375 daily copay for the first six days of an inpatient hospital stay, with no coinsurance required. Supplemental benefits include preventive dental care with no copay and a $250 annual allowance for eyewear with no copay. Routine eye and hearing exams are available for a $10 copay, while prescription hearing aids require copays ranging from $499 to $999. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, and members receive a $75 quarterly reimbursement for over-the-counter health items.
Inpatient Hospital See details
Clover Health LiveHealthy (PPO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 6 for acute stays and a $320 daily copay for days 1 to 6 for psychiatric stays, with no copay for days 7 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, although unlimited additional acute care days are covered with no copay.
Outpatient Services See details
Clover Health LiveHealthy (PPO) covers outpatient services with no coinsurance, including a $295 copay for outpatient hospital and observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $15 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Clover Health LiveHealthy (PPO) covers partial hospitalization services with a $70.00 copayment and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Clover Health LiveHealthy (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Clover Health LiveHealthy (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency services are covered up to a $50,000 maximum with no coinsurance, requiring copays of $115 for emergency coverage, $40 for urgent care, and $350 for emergency transportation.
Primary Care See details
Primary care benefits under Clover Health LiveHealthy (PPO) include primary care physician visits with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Therapy, psychiatric, mental health, and opioid treatment services require a $15 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Clover Health LiveHealthy (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Although several additional benefits like health education, nutritional therapy, and in-home safety assessments are not covered, members do receive coverage for memory fitness and remote access technologies with no copay or coinsurance.
Hearing Services See details
Clover Health LiveHealthy (PPO) covers hearing exams with a $10 copay and no coinsurance, including one routine exam annually and unlimited fitting evaluations. Prescription hearing aids are partially covered with a copay ranging from $499 to $999 and no coinsurance for up to two aids per year, while over-the-counter (OTC), inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Clover Health LiveHealthy (PPO) offers partially covered vision services with no deductibles, featuring a $10 copay and no coinsurance for one annual routine eye exam, while other eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a $250 yearly limit for one pair of contacts or eyeglasses, though separate frames, lenses, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Clover Health LiveHealthy (PPO), with orthodontics not covered, up to a combined annual maximum of $1,000. Medicare-covered dental services require a $10 copay and no coinsurance, preventive care has no copay or coinsurance, and comprehensive services generally have 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, although prior authorization is required. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Clover Health LiveHealthy (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Clover Health LiveHealthy (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance, though prior authorization is required. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Clover Health LiveHealthy (PPO), with lab services featuring no copay and no coinsurance, and other diagnostic tests ranging from a $0 to $175 copay with no coinsurance. Diagnostic radiological services require a minimum $50 copay, outpatient X-rays have a $30 copay, and therapeutic radiological services require a minimum 20% coinsurance, with prior authorization required.
Home Health Services See details
Home Health Services are covered under the Clover Health LiveHealthy (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Clover Health LiveHealthy (PPO) covers Cardiac Rehabilitation Services with no coinsurance, although prior authorization is required. While some services are covered, specific benefits including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require 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, but a prior three-day inpatient hospital stay is not, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Clover Health LiveHealthy (PPO) partially covers other services, offering an over-the-counter (OTC) benefit with no copay and no coinsurance up to $75 every three months via reimbursement. Acupuncture and meal benefits are not covered under this plan.
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