A non-government entity
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:
Sign up for Clever Care Longevity (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Clever Care Longevity (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic drugs at a standard pharmacy, while you will pay a $47 copay for standard generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Clever Care Longevity (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services like substance abuse treatment have a $40 copay. Emergency services have a $90 copay, but urgently needed services have no copay. This plan also includes coverage for preventive services, vision, dental, and hearing, with specific copays, coinsurance, and maximum benefits. Additionally, the plan covers home health, skilled nursing, and other services like acupuncture and over-the-counter items, with some requiring prior authorization or referrals.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. 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, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the Clever Care Longevity (HMO) plan, but requires prior authorization and a doctor's referral. The plan does not mention any cost information for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clever Care Longevity (HMO) plan. Ground ambulance services have a $100 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 24 one-way trips per year, but transportation to any health-related location is 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 under the Clever Care Longevity (HMO) plan. Emergency Services have a $90 copay, and there is no coinsurance, while Urgently Needed Services have no copay or coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $85,000.
Primary Care See details
Clever Care Longevity (HMO) covers Primary Care Physician Services, Occupational Therapy, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services are covered, but routine chiropractic care is not covered. Individual and Group Sessions for Mental Health and Psychiatric Services have a $40 copay.
Preventive Services See details
The Clever Care Longevity (HMO) plan covers preventive services, including annual physical exams and additional preventive services with a copay for Remote Access Technologies, including Web/Phone-based technologies and Nursing Hotline. The plan also covers Personal Emergency Response Systems (PERS), Alternative Therapies (up to 24 visits), Fitness Benefit (Memory Fitness, up to $225 every three months), and Remote Access Technologies with a copay between $0 and $40. The plan also covers Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all requiring prior authorization and/or a referral.
Hearing Services See details
The Clever Care Longevity (HMO) plan covers hearing exams, including routine hearing exams, and fitting/evaluation for hearing aids. The plan also covers prescription hearing aids, with a maximum benefit of $600 per year per ear, and OTC hearing aids with a maximum benefit of $225 every three months for both ears combined; however, prescription hearing aids are not covered for inner ear, outer ear, or over the ear.
Vision Services See details
Vision Services are covered, including routine eye exams, eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year, while eyewear has a combined maximum benefit of $200 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited.
Dental Services See details
The Clever Care Longevity (HMO) plan covers a maximum of $550 for dental services every three months. Oral exams are covered for 2 visits per year, dental x-rays are covered for 1 per year, and prophylaxis (cleaning) is covered for 2 visits per year. Other diagnostic dental services and other preventive dental services are unlimited, while fluoride treatments are covered for 1 visit per year. Orthodontics is not covered by this plan.
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, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis services are covered under the Clever Care Longevity (HMO) plan, but require prior authorization and a doctor's referral. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Clever Care Longevity (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, but 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), with no copay required. 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 the Clever Care Longevity (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Clever Care Longevity (HMO) plan, but none of the sub-services are covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Clever Care Longevity (HMO) with prior authorization and a doctor's referral. There is no copay for days 1-20, and a $75 copay for days 21-100, and additional and non-Medicare-covered days are not covered.
Other Services See details
The Clever Care Longevity (HMO) plan covers acupuncture with a maximum benefit coverage amount of $1,900 per year, and over-the-counter (OTC) items with a maximum benefit coverage amount of $225 every three months, including nicotine replacement therapy and naloxone. Meal benefits are covered for chronic illnesses, but require prior authorization and a doctor's referral. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and private duty nursing services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved