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Clover Health LiveHealthy Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health LiveHealthy 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 LiveHealthy Value (PPO) in 2026, please refer to our full plan details page.
Clover Health LiveHealthy Value (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 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 LiveHealthy 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 LiveHealthy Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $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:
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Drug Coverage
The Clover Health LiveHealthy Value (PPO) plan features a $150 drug deductible before coverage begins. Under this plan, there is no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications filled at standard pharmacies or through a 3-month standard mail-order service. For brand-name and specialty medications, costs are based on a percentage of the drug's price. You will pay a 25% coinsurance for Tier 3 (Preferred Brand) drugs, 35% coinsurance for Tier 4 (Non-Preferred) drugs, and 31% coinsurance for Tier 5 (Specialty) drugs at standard pharmacies and through standard mail order.
Additional Benefits
The Clover Health LiveHealthy Value (PPO) plan offers robust medical coverage featuring no copay for primary care visits, preventive services, and home health care. Specialist visits, physical therapy, and routine vision or hearing exams are highly affordable with a low $5 copay and no coinsurance. For more intensive care, inpatient hospital stays require a $290 daily copay for the first six days, while outpatient hospital visits have a $300 copay. In addition to core medical care, the plan includes valuable everyday benefits like dental coverage up to a $2,000 annual maximum with no copay for preventive services. Members also receive a $250 annual eyewear allowance and a $125 quarterly reimbursement for over-the-counter items with no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Clover Health LiveHealthy Value (PPO) covers inpatient hospital services with no coinsurance, requiring a $290 daily copay for days 1 through 6 and no copay for days 7 through 90 per stay. Unlimited additional acute care days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Clover Health LiveHealthy Value (PPO) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $300 copay, and ambulatory surgical center services for a $250 copay. Outpatient substance abuse services require a $10 copay for group sessions and a $20 copay for individual sessions with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Clover Health LiveHealthy Value (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Clover Health LiveHealthy Value (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Routine transportation services, including trips to plan-approved or other health-related locations, are not covered.
Emergency Services See details
Clover Health LiveHealthy Value (PPO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with no coinsurance and copays ranging from $40 to $350.
Primary Care See details
Clover Health LiveHealthy Value (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $5 copay and no coinsurance. Mental health, psychiatric, telehealth, and opioid treatment services have copays ranging from $0 to $20 with no coinsurance, but podiatry is not covered and chiropractic care is only partially covered, with routine and other chiropractic services excluded.
Preventive Services See details
Preventive services are covered by Clover Health LiveHealthy Value (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are partially covered, offering memory fitness and remote access technologies, while services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Clover Health LiveHealthy Value (PPO) provides partially covered hearing services, which include one routine annual hearing exam for a $5 copay and no coinsurance, and unlimited fitting evaluations. Up to two prescription hearing aids are covered per year with a copay ranging from $499 to $999 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Clover Health LiveHealthy Value (PPO) partially covers vision services, offering one routine eye exam per year with a $5 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $250 annual limit for one pair of contact lenses or eyeglasses, but upgrades, separate eyeglass lenses, and separate eyeglass frames are not covered.
Dental Services See details
Clover Health LiveHealthy Value (PPO) offers partially covered dental services up to a $2,000 annual maximum, though orthodontic services are not covered. Preventive care features no copay and no coinsurance, Medicare-covered services require a $5 copay and no coinsurance, and most comprehensive services require a $20 copay and no coinsurance, except removable prosthodontics which has no copay and 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Clover Health LiveHealthy Value (PPO) with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered under the Clover Health LiveHealthy Value (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Clover Health LiveHealthy Value (PPO) covers medical equipment with no copay, though a 20% coinsurance and prior authorization are required for durable medical equipment, prosthetics, and medical supplies. While diabetic equipment is covered with no copay or coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Clover Health LiveHealthy Value (PPO) diagnostic and radiological services are covered with prior authorization, offering diagnostic tests with no coinsurance and a copay of $0 to $200, and lab services with no copay. Radiological services include a $30 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Clover Health LiveHealthy Value (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Clover Health LiveHealthy Value (PPO) with no coinsurance, but in practice only some services are covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $5 copay.
Skilled Nursing Facility (SNF) See details
Clover Health LiveHealthy 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, followed by a $218 daily copay for days 21 through 100, though days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Clover Health LiveHealthy Value (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $125 reimbursement limit every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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