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Clover Health Valor (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health Valor (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clover Health Valor (PPO) in 2025, please refer to our full plan details page.
Clover Health Valor (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 Valor (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Clover Health Valor (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 Valor (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 $130.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $11999.00 (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 $11999.00 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
Prescription drugs are not covered by Clover Health Valor (PPO).
Additional Benefits
The Clover Health Valor (PPO) plan offers a variety of benefits with varying costs. For inpatient hospital stays, you'll pay a copay for the first few days, but no copay for the majority of your stay. Outpatient services often involve coinsurance or copays, with specific amounts depending on the service. This plan includes coverage for primary care visits with a copay, along with vision and dental services, also with copays. The plan also covers home health services with no cost, and offers coverage for ambulance, emergency, and hearing services with copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $360 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $320 copay for days 1-6, and no copay for days 7-90. Additional days 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 include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 20% coinsurance, while individual outpatient substance abuse sessions have a $35 copay, and group sessions have a $25 copay; outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Clover Health Valor (PPO) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clover Health Valor (PPO) plan, with prior authorization required for all ambulance services. Medicare-covered ground and air ambulance services have a $350 copay and no coinsurance, while 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 Valor (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $25 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $350 copay; all services have no coinsurance.
Primary Care See details
The Clover Health Valor (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a $25 copay. Mental health and psychiatric individual sessions have a $35 copay, and group sessions have a $25 copay; the plan also covers physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a $10-$25 copay, and opioid treatment program services with a $35 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Clover Health Valor (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services. Some additional preventive services, such as Health Education, In-Home Safety Assessment, and Personal Emergency Response System (PERS), are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $25 copay for up to one visit every year, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $699 and $999 for up to two hearing aids every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a $25 copay, contact lenses, and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $25 copay for Medicare dental services. Other services like oral exams, dental x-rays, and other diagnostic dental services have a $20 copay, while prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics fixed, and oral and maxillofacial surgery have a $20 copay. Prosthodontics, removable has a 50% coinsurance. Orthodontics are not covered. There is a $1500 annual maximum for all dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B insulin drugs, are covered under the Clover Health Valor (PPO) plan. The copay for Medicare Part B insulin drugs is $35, and there is a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Clover Health Valor (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Clover Health Valor (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and requires authorization. Prosthetic Devices and Medical Supplies also have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Clover Health Valor (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $250, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $250, while Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Clover Health Valor (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Clover Health Valor (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clover Health Valor (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay per day for days 21-100; additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services with the Clover Health Valor (PPO) plan covers over-the-counter items with a maximum benefit of $100 every three months. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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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