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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 $54.00. 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 $150.00 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 $13300.00 (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 $13300.00 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 Value (PPO)
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Drug Coverage
The Clover Health Choice Value (PPO) plan features a $150 drug deductible and provides excellent savings on generic medications. Tier 1 preferred generics are available with no copay for up to a three-month supply at standard pharmacies and through standard mail order. Tier 2 generics cost a $3 copay for a one-month supply at standard pharmacies, but you can avoid this cost entirely with no copay for a three-month supply through standard mail order. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require a 25% coinsurance, and Tier 4 non-preferred drugs have a 35% coinsurance for standard pharmacy and mail-order options. Tier 5 specialty medications are covered with a 31% coinsurance for all supply durations.
Additional Benefits
The Clover Health Choice Value (PPO) plan offers affordable coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a low $2 copay, while emergency care has a $115 copay, with no coinsurance for either service. For hospital stays, there is no coinsurance, though members will pay daily copays for the first six days of inpatient acute or psychiatric care before transitioning to no copay for longer stays. This Medicare Advantage plan also covers dental, vision, and hearing services, including routine eye and hearing exams for a low $2 copay and preventive dental care with no copay. Members also benefit from a $180 quarterly allowance for over-the-counter items and no copays for home infusion services and diabetic equipment. While many diagnostic and medical services require no copays, some specialized care, such as dialysis and durable medical equipment, features a 20% coinsurance.
Inpatient Hospital See details
Clover Health Choice Value (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 6 of acute stays and a $339 daily copay for days 1 to 6 of psychiatric stays, with no copay for days 7 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Clover Health Choice Value (PPO) with no coinsurance, including ambulatory surgical center and blood services at no copay. Patients will pay a $0 to $370 copay for outpatient hospital services, a $370 copay per stay for observation services, and a $10 to $20 copay per session for outpatient substance abuse services.
Partial Hospitalization See details
Clover Health Choice Value (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 Value (PPO) covers Medicare-approved ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Clover Health Choice Value (PPO) with a $115 copay and no coinsurance, while urgently needed care carries a $35 copay and no coinsurance, with both copays waived if admitted within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 limit with no coinsurance, featuring copays of $115, $40, and $350 respectively.
Primary Care See details
Clover Health Choice Value (PPO) offers primary care visits with no copay and no coinsurance, and specialist visits with a $2 copay and no coinsurance. Physical, occupational, and speech therapies require a $15 copay and no coinsurance, while podiatry is not covered, and although some services are covered, routine and other chiropractic services are not. Mental health, psychiatric, and telehealth services are covered with copays ranging from $0 to $20 and no coinsurance.
Preventive Services See details
Preventive services are covered by Clover Health Choice Value (PPO) with no copay and no coinsurance for annual physicals, kidney disease education, and other screenings. This benefit is partially covered because it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling. Memory fitness and remote access technologies are covered under the plan's additional preventive benefits.
Hearing Services See details
Hearing services are covered by Clover Health Choice Value (PPO), which offers routine hearing exams and fitting evaluations for a $2.00 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $499.00 and $999.00, but over-the-counter hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Clover Health Choice Value (PPO), featuring one routine eye exam per year for a $2.00 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered with no copay and no coinsurance up to a $300 annual limit for one pair of contacts or eyeglasses per year, though individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Clover Health Choice Value (PPO) offers partially covered dental services with an annual maximum of $1,500, featuring no copay and no coinsurance for preventive care. Most comprehensive services require a $20 copay and no coinsurance, while removable prosthodontics require no copay and 50% coinsurance, and orthodontic services are not covered.
Home Infusion bundled Services See details
Clover Health Choice Value (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Clover Health Choice Value (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Clover Health Choice Value (PPO) covers medical equipment with no copays, though durable medical equipment, prosthetics, and medical supplies require prior authorization and a 20% coinsurance. Diabetic equipment is covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Clover Health Choice Value (PPO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests with no coinsurance and a $0 to $200 copay. Outpatient X-rays require a $30 copay, diagnostic radiological services have a minimum $50 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Clover Health Choice Value (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Clover Health Choice Value (PPO) with no coinsurance, though prior authorization is required and a copay applies to covered services. While some services are covered, 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 allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered benefit are not covered.
Other Services See details
Clover Health Choice Value (PPO) partially covers other services, providing up to $180 every three months in reimbursement for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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