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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 NJ and PA 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 $125.00. 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 $13900.00 (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 $13900.00 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 robust healthcare coverage with no copay for primary care visits, home health services, and preventive care. For specialist visits, members pay a $30 copay, while inpatient hospital stays require a daily copay for the first six days before transitioning to no copay. Outpatient services, medical equipment, and dialysis are covered with no copay and a standard 20% coinsurance. This plan also includes valuable supplemental benefits, such as a $1,500 annual dental allowance, a $200 eyewear allowance, and an over-the-counter benefit of $100 every three months. Emergency care is accessible worldwide with a $115 copay, and routine vision and hearing exams are available for a $30 copay.
Inpatient Hospital See details
Clover Health Valor (PPO) partially covers inpatient hospital care with no coinsurance, requiring a $399 daily copay for days 1 through 6 of acute stays (no copay for days 7 and beyond) and a $335 daily copay for days 1 through 6 of psychiatric stays (no copay for days 7 through 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Clover Health Valor (PPO) covers outpatient hospital, observation, and ambulatory surgical center services with no copay and a 20% coinsurance. Outpatient substance abuse services feature no coinsurance with copays of $45 for individual and $35 for group sessions, while outpatient blood services require no copay, no deductible, and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Clover Health Valor (PPO) plan with no copay and a 20% coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Clover Health Valor (PPO), with ground and air ambulance services requiring a $350 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Clover Health Valor (PPO) covers emergency services with a $115 copay and urgently needed services with a $25 copay, both with no coinsurance and waived if admitted within 24 hours. Worldwide emergency coverage is available up to $50,000 with no coinsurance, featuring copays of $115 for emergency, $40 for urgent, and $350 for transportation services.
Primary Care See details
Clover Health Valor (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay and no coinsurance, while podiatry is not covered and chiropractic services are partially covered, with routine and other chiropractic care not covered.
Preventive Services See details
Preventive Services are partially covered by Clover Health Valor (PPO) with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, memory fitness, and remote access technologies. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, safety devices, and counseling are not covered.
Hearing Services See details
Hearing Services are partially covered by Clover Health Valor (PPO), offering one routine hearing exam per year for a $30 copay and no coinsurance, alongside unlimited fitting evaluations. Up to two prescription hearing aids are covered annually with no coinsurance and a copay between $499 and $999, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Clover Health Valor (PPO) offers partially covered vision services, featuring one routine eye exam per year with a $30 copay and no coinsurance, and a $200 annual allowance for eyewear with no copay and no coinsurance. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by Clover Health Valor (PPO) with an annual maximum benefit of $1,500 for in-network and out-of-network care, though orthodontics is not covered. Preventive care and removable prosthodontics have no copay (with no coinsurance and 50% coinsurance, respectively), while Medicare-covered dental services require a $30 copay and most comprehensive services require a $20 copay, both with no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Clover Health Valor (PPO) with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
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 (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for DME and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Clover Health Valor (PPO) with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic tests have a $0 to $250 copay and no coinsurance, and radiological services require a $40 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Clover Health Valor (PPO) with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Clover Health Valor (PPO) with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice, carrying copays of $30, $35, $15, and $20 respectively.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Clover Health Valor (PPO) with no coinsurance and do not require 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 prior authorization is required and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other Services are partially covered under Clover Health Valor (PPO), which offers an over-the-counter (OTC) benefit with no copay and no coinsurance up to $100 every three months via reimbursement. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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