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Clover Health Choice Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health Choice Giveback (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 Giveback (PPO) in 2026, please refer to our full plan details page.
Clover Health Choice Giveback (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 Giveback (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 Giveback (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 Giveback (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 $110.00. 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 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 Choice Giveback (PPO) prescription drug coverage has an annual drug deductible of $200. Tier 1 preferred generic drugs feature no copay at standard pharmacies and standard mail order. Tier 2 generic drugs have an $8 copay for a 1-month supply at standard pharmacies, but they are available with no copay for a 3-month standard mail order. Tier 3 preferred brand drugs have a $47 copay for a 1-month supply at standard pharmacies, while Tier 4 non-preferred drugs cost a $100 copay. Specialty drugs in Tier 5 require a 30% coinsurance for both standard pharmacy and standard mail order fills. These clear copayment and coinsurance rates help you easily estimate your out-of-pocket prescription costs with this plan.
Additional Benefits
The Clover Health Choice Giveback (PPO) offers comprehensive medical coverage with no copay or coinsurance for primary care visits and routine preventive services. Specialist visits require a $30 copay, while inpatient hospital stays incur a $350 daily copay for the first six days of acute care. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes essential supplemental benefits, such as preventive dental care with no copay and up to $1,000 in annual dental coverage. Vision and hearing routine exams require a $30 copay, with additional allowances of up to $200 annually for eyewear and coverage for prescription hearing aids. Additionally, members receive up to a $50 quarterly reimbursement for eligible over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Clover Health Choice Giveback (PPO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 6 of acute stays and a $320 daily copay for days 1 to 6 of psychiatric stays, with no copay for days 7 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Clover Health Choice Giveback (PPO) covers outpatient services with no coinsurance, including outpatient hospital and observation services for a $375 copay, and ambulatory surgical center services for a $325 copay. Outpatient substance abuse services require no coinsurance and have a $45 copay for individual sessions and a $35 copay for group sessions, while outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Clover Health Choice Giveback (PPO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Clover Health Choice Giveback (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Clover Health Choice Giveback (PPO) covers emergency services with a $115 copay and no coinsurance, and urgent care with a $40 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered up to a $50,000 maximum benefit with no coinsurance, requiring a $115 copay for emergency care, a $40 copay for urgent care, and a $350 copay for emergency transportation.
Primary Care See details
Clover Health Choice Giveback (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapy, as well as opioid treatment, require a $35 copay and no coinsurance, while individual mental health and psychiatric sessions carry a $45 copay (group sessions are $35) with no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the Clover Health Choice Giveback (PPO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are only partially covered; memory fitness and remote access technologies are included, but services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Clover Health Choice Giveback (PPO), which features a $30 copay and no coinsurance for an annual routine hearing exam. While up to two prescription hearing aids per year are covered with a copay between $499 and $999 and no coinsurance, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Clover Health Choice Giveback (PPO) features partially covered vision services with no deductibles, including one annual routine eye exam for a $30 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $200 annual limit for one pair of contact lenses or eyeglasses (lenses and frames) per year, while other eye exams, separate lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Clover Health Choice Giveback (PPO), which offers up to $1,000 in yearly benefits for both in-network and out-of-network care. Preventive care has no copay and no coinsurance, comprehensive services require a $20 copay and no coinsurance (except removable prosthodontics at a 50% coinsurance with no copay), and Medicare-covered dental has a $30 copay and no coinsurance; orthodontics is not covered.
Home Infusion bundled Services See details
Clover Health Choice Giveback (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Clover Health Choice Giveback (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by Clover Health Choice Giveback (PPO), featuring no copays and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. 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
Clover Health Choice Giveback (PPO) covers diagnostic services with no coinsurance, offering no copay for lab services and a copay ranging from $0 to $350 for diagnostic procedures. Radiological services are also covered, featuring a $30 copay for outpatient X-rays, a copay starting at $50 for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Clover Health Choice Giveback (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Clover Health Choice Giveback (PPO) provides some cardiac rehabilitation services with no coinsurance and required prior authorization. However, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Clover Health Choice Giveback (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, although prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Clover Health Choice Giveback (PPO) partially covers Other Services, providing up to a $50 reimbursement every three months for Over-the-Counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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