A non-government entity
Clover Health Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health Choice (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 (PPO) in 2026, please refer to our full plan details page.
Clover Health Choice (PPO) is a PPO plan offered by Clover Health Holdings, Inc. available for enrollment in 2025 to people living in Bucks, Philadelphia & Delaware 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 (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 (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 (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 $9999.00 (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 $9999.00 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 Choice (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Clover Health Choice (PPO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no out-of-pocket deductible costs. For Tier 1 preferred generic drugs, there is no copay for up to a 3-month supply at standard pharmacies or via standard mail order. Tier 2 generic drugs cost $8 for a 1-month supply at a standard pharmacy, but you can secure a 3-month supply with no copay through standard mail order. Higher-tier prescriptions under this plan require copayments or coinsurance, such as Tier 3 preferred brand drugs which carry a $47 copay for a 1-month supply at standard pharmacies. Tier 4 non-preferred drugs cost $100 for a 1-month standard pharmacy supply, while Tier 5 specialty drugs require a 33% coinsurance. Opting for a 3-month standard mail order can help manage costs, offering a $135 copay for Tier 3 and a $300 copay for Tier 4 drugs.
Additional Benefits
The Clover Health Choice (PPO) plan offers comprehensive medical coverage with predictable copays and no coinsurance for many primary services. Members benefit from no copay for primary care physician visits, covered preventive care, and home health services, while specialist visits require a low $2 copay. Inpatient hospital stays carry a $295 daily copay for days 1 through 6, while outpatient hospital services require a $300 copay with no coinsurance. Supplemental benefits include dental coverage up to $1,500 annually with no copay for preventive care and a $20 copay for most comprehensive services. Routine vision and hearing exams are available for a $2 copay, alongside a $250 annual eyewear allowance and a $115 quarterly over-the-counter allowance with no copays. Prescription hearing aids are covered with copays ranging from $499 to $999, while durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
Clover Health Choice (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional days are covered with no copay for acute stays, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Clover Health Choice (PPO) covers outpatient hospital and observation services for a $300 copay and ambulatory surgical center services for a $150 copay, all with no coinsurance. Outpatient substance abuse services are covered with no coinsurance and a $15 to $25 copay, while outpatient blood services are available with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Clover Health Choice (PPO) covers partial hospitalization services with an $80 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Clover Health Choice (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, subject to prior authorization. Transportation services are not covered under this plan.
Emergency Services See details
Clover Health Choice (PPO) covers emergency services with a $115 copay and urgently needed services with a $25 copay, both featuring no coinsurance and copay waivers if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $50,000 maximum limit, carrying copays of $115, $40, and $350, respectively.
Primary Care See details
Clover Health Choice (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $2 copay and no coinsurance. Occupational, physical, speech, and opioid treatment therapies require a $15 copay and no coinsurance, while chiropractic and podiatry services are not covered. Mental health, psychiatric, and telehealth services feature no coinsurance, with copays ranging from no copay up to $25 depending on the service.
Preventive Services See details
Preventive Services are partially covered under the Clover Health Choice (PPO) plan with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and diabetes self-management training. While memory fitness and remote access technologies are covered, several additional preventive services—such as health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, weight management programs, and counseling—are not covered.
Hearing Services See details
Clover Health Choice (PPO) offers partially covered hearing services, which include routine hearing exams for a $2.00 copay and no coinsurance, and unlimited fitting evaluations. Prescription hearing aids are covered with no coinsurance and a copay ranging from $499.00 to $999.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services under Clover Health Choice (PPO) are partially covered, featuring one annual routine eye exam for a $2.00 copay and no coinsurance with no deductible, while other eye exam services are not covered. Eyewear is also partially covered with no copay, no coinsurance, and no deductible up to a $250 annual limit for one pair of contact lenses or eyeglasses, though individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Clover Health Choice (PPO) up to an annual maximum of $1,500 for both in-network and out-of-network care, though orthodontics are not covered. Preventive services require no copay and no coinsurance, Medicare-covered dental has a $2.00 copay and no coinsurance, and comprehensive services generally carry a $20.00 copay and no coinsurance, except for removable prosthodontics which has no copay and a 50% coinsurance.
Home Infusion bundled Services See details
Clover Health Choice (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Clover Health Choice (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Clover Health Choice (PPO) partially covers medical equipment with no copays, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Covered durable medical equipment, prosthetics, and medical supplies require a 20% coinsurance, while diabetic equipment is available with no coinsurance.
Diagnostic and Radiological Services See details
Clover Health Choice (PPO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and no copay for lab services, and diagnostic tests ranging from no copay up to $175. Outpatient X-rays require a $30 copay, diagnostic radiology has a minimum $50 copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home health services are fully covered by the Clover Health Choice (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Clover Health Choice (PPO) with no coinsurance and prior authorization required, but some services are not covered, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, which carry a $15 copay.
Skilled Nursing Facility (SNF) See details
Clover Health Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Clover Health Choice (PPO) partially covers Other Services, offering Over-the-Counter (OTC) items with no copay and no coinsurance up to $115 every three months. Acupuncture, Meal Benefits, and other additional services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved