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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. Additionally, this plan comes with a Part B Premium reduction of $1.20. 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 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. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs and specialty tier drugs, there is no copay. For standard generic drugs, the copay is $47.00, and for preferred brand drugs, the copay is $99.00. For non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Clever Care Longevity (HMO) plan provides a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance amounts. Emergency services have a $90 copay, and ambulance services have a $100 copay for ground transport and 20% coinsurance for air transport. The plan also offers coverage for vision, hearing, and dental services, with specific limits and copays. Additional benefits include home health services with no copay, and coverage for medical equipment and home infusion services with coinsurance. The plan covers preventive services, including annual physical exams, and offers coverage for other services such as acupuncture, with a maximum annual benefit. However, some services, such as cardiac rehabilitation and certain home health services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization and a doctor referral required. For Inpatient Hospital Psychiatric, there is a $150 copay for days 1-7, and no copay for days 8-90, while additional days and non-Medicare-covered stays are not covered.
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 by the Clever Care Longevity (HMO) plan. Individual and group sessions for outpatient substance abuse have a copay between $40.00 and $40.00.
Partial Hospitalization See details
Partial Hospitalization is covered by Clever Care Longevity (HMO) with prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clever Care Longevity (HMO) plan, including both ground and air ambulance services. Ground ambulance services have a $100 copay, while air ambulance services have a 20% coinsurance; Transportation Services to any health-related location are covered for 24 one-way trips per year via bus/subway or other modes.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services 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. Worldwide Emergency Services has a maximum plan benefit coverage of $85,000.
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. Individual and group sessions for mental health and psychiatric services have a $40 copay. Chiropractic services, and opioid treatment program services require prior authorization and a doctor referral, while routine chiropractic care is not covered.
Preventive Services See details
The Clever Care Longevity (HMO) plan covers preventive services, including annual physical exams, with additional preventive services that may include a copay. Additional services include Personal Emergency Response System (PERS), Alternative Therapies (24 visits), Fitness Benefit, and Remote Access Technologies, which may have a copay between $0 and $40. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit are covered, but require prior authorization.
Hearing Services See details
Hearing Services includes coverage for hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (3 per year). The plan also covers prescription hearing aids, with a maximum benefit of $600 per ear every year, and OTC hearing aids up to $225 every three months for both ears combined. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered, including eye exams with no copay or deductible, and eyewear with a combined maximum benefit of $200 every year. Routine eye exams are covered once per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Clever Care Longevity (HMO) plan offers dental services, with a maximum benefit of $550 every three months. Oral exams are limited to 2 per year, dental x-rays are limited to 1 per year, while other diagnostic dental services and other preventive dental services are unlimited.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, you will pay a $35 copay, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay coinsurance between 0% and 20%.
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 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, though DME for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit and Diabetic Therapeutic Shoes/Inserts are covered with a coinsurance, and Prosthetic Devices have a 20% coinsurance; however, Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Clever Care Longevity (HMO). Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered, while Therapeutic Radiological Services have a coinsurance of at most 20%, and all other services have no copay.
Home Health Services See details
Home Health Services are covered by the Clever Care Longevity (HMO) plan with no copay and no coinsurance, but requires authorization and a referral. 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. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clever Care Longevity (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for days 1-20, and a $75 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Clever Care Longevity (HMO) plan, acupuncture is covered with a maximum plan benefit coverage amount of $1900.00 every year, while Over-the-Counter (OTC) items are covered with a maximum plan benefit coverage amount of $225.00 every three months, and the plan also offers a meal benefit for a chronic illness. Several other services, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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