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Clever Care Longevity (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clever Care Longevity (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clever Care Longevity (HMO) in 2025, please refer to our full plan details page.
Clever Care Longevity (HMO) is a HMO plan offered by Clever Care Health Plan, Inc. available for enrollment in 2025 to people living in Southern California. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Clever Care Longevity (HMO) 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 Clever Care Longevity (HMO).
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 Clever Care Longevity (HMO), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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
The Clever Care Longevity (HMO) plan has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, you will pay no copay for preferred generic drugs at standard or mail order pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Clever Care Longevity (HMO) plan offers a wide range of benefits with varying costs. You can expect no copay for many services, including preventive care, home health services, and primary care services such as occupational and physical therapy. However, you'll pay a copay for emergency services ($90), inpatient psychiatric care ($150), and outpatient substance abuse sessions ($40). The plan also includes coverage for hearing, vision, and dental services with specific allowances for hearing aids, eyewear, and a variety of dental procedures. Additional benefits include coverage for ambulance services, with a $100 copay for ground and 20% coinsurance for air ambulance services, plus coverage for home infusion bundled services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, and outpatient substance abuse services, are covered. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $40.00 and $40.00. Outpatient Blood Services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Clever Care Longevity (HMO) plan, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Clever Care Longevity (HMO), including both ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $100 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Clever Care Longevity (HMO) plan. For Emergency Services, there is a $90 copay and no coinsurance, and the copay is waived if admitted to the hospital within 72 hours.
Primary Care See details
The Clever Care Longevity (HMO) plan covers Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. The plan does not have a copay or coinsurance for Occupational Therapy and Physical Therapy, and the plan requires a $40 copay for individual and group sessions for both Mental Health and Psychiatric Services, as well as Opioid Treatment Program Services. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Clever Care Longevity (HMO) plan covers preventive services, including annual physical exams and additional services like alternative therapies, and fitness benefits. Some services, such as health education, and counseling services are not covered. The plan may require a referral or prior authorization for some services.
Hearing Services See details
The Clever Care Longevity (HMO) plan covers hearing exams with no deductible, and routine hearing exams once per year. This plan also covers fitting/evaluation for hearing aids up to 3 times per year, and prescription hearing aids with a maximum benefit of $600 per year per ear, and OTC hearing aids up to $225 every three months for both ears combined.
Vision Services See details
Vision services include coverage for eye exams, with one routine eye exam covered per year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $200 per year for all eyewear. Routine eye exams require prior authorization.
Dental Services See details
The Clever Care Longevity (HMO) plan offers a dental services benefit that includes coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery; however, orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and other Medicare Part B drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Clever Care Longevity (HMO) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Clever Care Longevity (HMO) plan, including Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetic Devices with 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Clever Care Longevity (HMO). There is no copay for any services. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered, while Therapeutic Radiological Services are covered with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Clever Care Longevity (HMO) with no copay and no coinsurance, but authorization and a referral are required. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under Clever Care Longevity (HMO), requiring prior authorization and a doctor referral. There is no copay for days 1-20, and a $75 copay for days 21-100, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Clever Care Longevity (HMO) plan covers acupuncture with a maximum benefit coverage amount of $1900 per year, and it covers over-the-counter items up to $225 every three months. The plan also offers a meal benefit for chronic illnesses, but requires prior authorization and a doctor referral. Other services such as 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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