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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 2026, 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 and South Carolina Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $140.00. 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:
Sign up for Clover Health Valor (PPO)
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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 comprehensive coverage for core medical services, featuring no copay and no coinsurance for primary care doctor visits and a $25 copay for specialist visits. Inpatient hospital stays require a $360 daily copay for the first six days and no copay for subsequent days, while outpatient hospital services carry a 20% coinsurance and no copay. Emergency room visits require a $115 copay, which is waived if you are admitted within 24 hours, while urgently needed care carries a $25 copay. For supplemental care, the plan features no copay for preventive dental services and a $20 copay for most comprehensive dental services up to a $1,500 annual limit. Routine vision and hearing exams are available for a $25 copay, and members receive a $250 annual allowance for eyewear with no copay. Additionally, the plan covers home health services and the first 20 days of skilled nursing facility care with no copay, alongside a $125 reimbursement every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Clover Health Valor (PPO) with no coinsurance, excluding upgrades and non-Medicare-covered stays. Prior authorized acute stays require a $360 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $320 daily copay for days 1 through 6 and no copay for days 7 through 90.
Outpatient Services See details
Clover Health Valor (PPO) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and a 20% coinsurance. Outpatient substance abuse services are covered with no coinsurance, requiring a $35 copay for individual sessions and a $25 copay for group sessions.
Partial Hospitalization See details
Clover Health Valor (PPO) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for some of these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Clover Health Valor (PPO), offering ground and air ambulance services for a $350 copay and no coinsurance, with prior authorization required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Clover Health Valor (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with no coinsurance and copays of $115, $40, and $350, respectively.
Primary Care See details
Clover Health Valor (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Physical, occupational, and speech therapies, along with individual mental health sessions, carry a $35 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Clover Health Valor (PPO) preventive services are partially covered with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, glaucoma screenings, and memory fitness. However, several additional preventive services are not covered, such as health education, in-home safety assessments, personal emergency response systems, nutritional/dietary benefits, and therapeutic massage.
Hearing Services See details
Clover Health Valor (PPO) partially covers hearing services with no deductible, offering annual routine hearing exams for a $25 copay and no coinsurance. Prescription hearing aids are also partially covered with no coinsurance and a copay ranging from $499 to $999 for up to two devices per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Clover Health Valor (PPO), which offers one routine eye exam per year for a $25 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 $250 yearly limit for one pair of eyeglasses or contact lenses, though separate lenses, frames, and upgrades are excluded.
Dental Services See details
Clover Health Valor (PPO) provides partially covered dental services up to a combined $1,500 annual maximum, though orthodontics is not covered. Medicare-covered dental requires a $25 copay and no coinsurance, preventive services have no copay and no coinsurance, and most comprehensive services carry a $20 copay and no coinsurance, except for removable prosthodontics which has no copay and a 50% coinsurance.
Home Infusion bundled Services See details
Clover Health Valor (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Clover Health Valor (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Clover Health Valor (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Clover Health Valor (PPO) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $250 copay for diagnostic procedures. Radiological services are also covered, featuring a $40 copay for outpatient X-rays, a minimum $50 copay for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Clover Health Valor (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Clover Health Valor (PPO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $35 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Clover Health Valor (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Clover Health Valor (PPO) partially covers Other Services, offering Over-the-Counter (OTC) items with no copay and no coinsurance up to a $125 reimbursement every three months. However, acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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