A non-government entity
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 San Antonio Area. 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 $150.00. 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 $10000.00 (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 $10000.00 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 provides comprehensive healthcare coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, members pay a $399 daily copay for the first six days and no copay thereafter, while specialist visits require a flat $45 copay. Outpatient services, dialysis, and medical equipment generally feature no copay but require coinsurance ranging from 15% to 20%. This plan also includes key supplemental benefits, featuring partially covered dental care up to a $1,500 annual limit with no copay for preventive services and a $20 copay for most comprehensive care. Routine vision and hearing exams are available for a $45 copay, with additional allowances of up to $200 for annual eyewear and up to two prescription hearing aids per year. Furthermore, members receive a $50 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Clover Health Valor (PPO) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Covered acute stays require a $399 copay for days 1 through 6 and no copay thereafter, while psychiatric stays require a $335 copay for days 1 through 6 and no copay for days 7 through 90.
Outpatient Services See details
Outpatient services are covered by Clover Health Valor (PPO), offering no copay and a 20% coinsurance for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse services require no coinsurance with a $35 copay for group sessions and a $45 copay for individual sessions, while outpatient blood services are covered with no copay and a 20% coinsurance.
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 covered services.
Ambulance and Transportation Services See details
Clover Health Valor (PPO) covers Medicare-approved ground and air ambulance services with a $350 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Clover Health Valor (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay with no coinsurance, and worldwide emergency services are covered up to $50,000 with no coinsurance and copays of $40 for urgent care, $130 for emergency care, and $350 for emergency transportation.
Primary Care See details
Clover Health Valor (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Additional services like physical therapy and mental health sessions feature copays ranging from $35 to $45 with no coinsurance, though podiatry is not covered and chiropractic care is only partially covered.
Preventive Services See details
Clover Health Valor (PPO) preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, are covered with no copay and no coinsurance. Additional preventive services are only partially covered, with memory fitness and remote access technologies included, while 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, smoking cessation, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Clover Health Valor (PPO) provides partially covered hearing services, featuring routine hearing exams for a $45 copay and no coinsurance, with no deductible. Up to two prescription hearing aids are covered per year with a copay ranging from $499.00 to $999.00 and no coinsurance, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Clover Health Valor (PPO) vision services are partially covered and feature no deductibles, offering one routine eye exam per year for a $45 copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual limit for one pair of contact lenses or eyeglasses, but separate lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Clover Health Valor (PPO) up to a $1,500 annual maximum, though orthodontics is not covered. Preventive care features no copay and no coinsurance, Medicare-covered services require a $45 copay and no coinsurance, and most comprehensive benefits have a $20 copay and no coinsurance, except for removable prosthodontics which has no copay and 50% coinsurance.
Home Infusion bundled Services See details
Clover Health Valor (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require no copay and 0% to 20% coinsurance, while 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, prosthetics, medical supplies, and diabetic equipment, with no copay and a 15% 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 and radiological services, with prior authorization required for these benefits. Diagnostic procedures and tests carry no coinsurance and a copay ranging from no copay to $250, lab services require no copay or coinsurance, and radiological services feature a $40 copay for X-rays, a minimum $50 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
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
Cardiac Rehabilitation Services are covered by Clover Health Valor (PPO) with no coinsurance and require prior authorization. While some services are covered, standard 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, though prior authorization is required and no prior three-day hospital stay is needed. 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 Valor (PPO) partially covers Other Services, offering Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum reimbursement of $50 every three months. Acupuncture, meal benefits, and other additional services under this category are not covered.
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