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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 2025, 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 4 out of 5 stars in 2025.
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 $29.40. 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 $200.00 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 $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:
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Drug Coverage
The Clover Health LiveHealthy Value (PPO) plan has a $200 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy used. For example, for a standard pharmacy, you will pay an $8 copay for preferred generic drugs, 25% coinsurance for standard generic drugs, 35% coinsurance for preferred brand drugs, and 30% coinsurance for non-preferred drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Clover Health LiveHealthy Value (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the specific service. This plan also includes coverage for hearing, vision, and dental services, with copays for exams and some procedures. The plan also offers additional benefits like home health and home infusion services.
Inpatient Hospital See details
Inpatient Hospital coverage under the Clover Health LiveHealthy Value (PPO) plan includes a $310 copay for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $300 copay. Ambulatory Surgical Center (ASC) Services have a $250 copay, and outpatient substance abuse services have a $20 copay for individual sessions and a $10 copay for group sessions. Outpatient blood services are also covered with a waived deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Clover Health LiveHealthy Value (PPO) plan, with a $70 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clover Health LiveHealthy Value (PPO) plan. Medicare-covered ground and air ambulance services have a $350 copay, and there is no coinsurance. 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 by the Clover Health LiveHealthy Value (PPO) plan. 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 Value (PPO) plan covers primary care, specialist, and mental health services with a $5 copay, while chiropractic services have a $5 copay. Occupational therapy and physical therapy services also have a $5 copay, and individual and group mental health and psychiatric sessions have copays ranging from $10 to $20. Additional telehealth benefits have copays ranging from $0 to $5, and opioid treatment program services have a $10 copay.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and other preventive services, are covered. Fitness Benefits, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit are also covered. Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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, Home and Bathroom Safety Devices and Modifications, Counseling Services, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $5 copay. Prescription Hearing Aids are partially covered, with a copay between $699 and $999 for all types of hearing aids (every year), but Inner Ear, Outer Ear, and Over the Ear aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $5 copay. Eyewear is covered, with a combined maximum benefit of $100 every year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are covered, with a limit of one pair per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Clover Health LiveHealthy Value (PPO) plan covers Medicare and other dental services, including oral exams, dental x-rays, and cleanings with a $5 copay for Medicare dental services and a maximum plan benefit of $1500 per year for other dental services. Restorative, adjunctive general, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics fixed, and oral and maxillofacial surgery have a $20 copay, while prosthodontics removable has a 50% coinsurance, and orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Clover Health LiveHealthy Value (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Clover Health LiveHealthy Value (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Clover Health LiveHealthy Value (PPO) plan, with a 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, and no copay. Some services are covered, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests have a copay between $0 and $200, Lab Services have no copay, Diagnostic Radiological Services have a copay between $50 and $200, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Clover Health LiveHealthy Value (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 Value (PPO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
The Clover Health LiveHealthy Value (PPO) plan covers Skilled Nursing Facility (SNF) services, but requires 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 SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $60.00 every three months, but acupuncture, meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services, Services in an Intermediate Care Facility, 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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