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Clover Health LiveHealthy Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health LiveHealthy 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 LiveHealthy Giveback (PPO) in 2026, please refer to our full plan details page.
Clover Health LiveHealthy Giveback (PPO) is a PPO plan offered by Clover Health Holdings, Inc. available for enrollment in 2026 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 LiveHealthy 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 LiveHealthy 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 LiveHealthy 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 $105.00. 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 $590.00 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 $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:
Sign up for Clover Health LiveHealthy Giveback (PPO)
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Drug Coverage
The Clover Health LiveHealthy Giveback (PPO) plan features an annual drug deductible of $590, though it offers no copay for Tier 1 preferred generic drugs at standard pharmacies and through standard mail order. For Tier 2 generic drugs, standard pharmacy copays start at $5 for a one-month supply, and standard mail order offers a three-month supply with no copay. Tier 3 preferred brand drugs require a $47 copay for a one-month standard pharmacy supply, while Tier 4 non-preferred drugs have a $100 copay. For specialty medications in Tier 5, members will pay a 26% coinsurance at standard pharmacies and through standard mail order.
Additional Benefits
The Clover Health LiveHealthy Giveback (PPO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs and no coinsurance for many options. Primary care visits, home health services, and annual preventive exams are available with no copay, while specialist visits require a $40 copay. For more intensive care, inpatient hospital stays require a daily copay for the first six days, and emergency room visits feature a $115 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits, such as dental preventive care with no copay up to a $500 annual limit and routine vision eyewear covered up to $150 yearly with no copay. Routine hearing exams carry a $40 copay, and prescription hearing aids are partially covered with copays ranging from $499 to $999. Additionally, members can access over-the-counter items with no copay up to a $50 quarterly reimbursement limit, while durable medical equipment is covered with a 20% coinsurance.
Inpatient Hospital See details
Clover Health LiveHealthy Giveback (PPO) covers inpatient hospital services with no coinsurance, requiring a $385 daily copay for days 1 to 6 of acute stays and a $335 daily copay for days 1 to 6 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and some services like non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Clover Health LiveHealthy Giveback (PPO) with no coinsurance, featuring a $450 copay for outpatient hospital and observation services and a $350 copay for ambulatory surgical center services. Outpatient substance abuse services require a $35 copay for group sessions and a $45 copay for individual sessions with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Clover Health LiveHealthy Giveback (PPO) covers partial hospitalization services with an $80.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Clover Health LiveHealthy Giveback (PPO), offering ground and air ambulance services for a $350 copay and no coinsurance, with prior authorization required. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Clover Health LiveHealthy Giveback (PPO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered up to a $50,000 maximum limit with no coinsurance, requiring copays of $115 for emergency care, $40 for urgent care, and $350 for emergency transportation.
Primary Care See details
Clover Health LiveHealthy Giveback (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits for a $40 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, some chiropractic services are covered for a $15 copay and no coinsurance (though routine and other chiropractic services are not covered), and podiatry is not covered.
Preventive Services See details
Preventive Services are partially covered by Clover Health LiveHealthy Giveback (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and glaucoma screenings. While memory fitness and remote access technologies are included, several supplemental benefits such as health education, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
Clover Health LiveHealthy Giveback (PPO) covers routine hearing exams with a $40 copay and no coinsurance, while prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $999. OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered under this plan.
Vision Services See details
Clover Health LiveHealthy Giveback (PPO) vision services are partially covered, offering one routine eye exam annually for a $40 copay and no coinsurance, with no deductible. Eyewear is covered with no copay, no coinsurance, and a $150 yearly limit for one pair of contacts or eyeglasses, though upgrades, separate lenses or frames, and other eye exam services are not covered.
Dental Services See details
Dental Services are partially covered by Clover Health LiveHealthy Giveback (PPO), offering Medicare-covered dental care for a $40 copay and no coinsurance, alongside preventive care with no copay and no coinsurance up to a $500 annual limit. Restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Clover Health LiveHealthy Giveback (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Clover Health LiveHealthy Giveback (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Clover Health LiveHealthy Giveback (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, though prior authorization is required. Diabetic equipment is 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 LiveHealthy Giveback (PPO) covers diagnostic services with no coinsurance, featuring a $10 copay for lab services and copays ranging from no copay to $350 for diagnostic tests. Covered radiological services require prior authorization and include a $45 copay with coinsurance 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 under the Clover Health LiveHealthy Giveback (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by the Clover Health LiveHealthy Giveback (PPO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, and pulmonary rehabilitation services (each with a $25 copay) along with SET for PAD services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Clover Health LiveHealthy Giveback (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by the Clover Health LiveHealthy Giveback (PPO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $50 reimbursement limit every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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