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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 a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts 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. For standard generic drugs, the copay is $47, and for preferred brand drugs, the copay is $99. Non-preferred drugs have a 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Clever Care Longevity (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services like substance abuse treatment have a $40 copay for individual and group sessions. Emergency services have a $90 copay, and ambulance services have a $100 copay for ground transport and 20% coinsurance for air ambulance. This plan also includes coverage for primary care, preventive services, and services like hearing, vision, and dental. Hearing aids are covered up to a certain amount, and vision care includes eye exams and eyewear. Dental services are covered up to a maximum amount, and the plan also offers additional benefits like acupuncture, OTC items, and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization and a doctor referral required. 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 of $40. Outpatient Blood Services are covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by Clever Care Longevity (HMO), but requires prior authorization and a doctor's referral. Details about the cost of services are not provided.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Clever Care Longevity (HMO), including ground ambulance services with a $100 copay and air ambulance services with 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the Clever Care Longevity (HMO) plan, with a $90 copay and no coinsurance. Urgently Needed Services are covered with no copay and no coinsurance, and Worldwide Emergency Services are covered with a maximum plan benefit coverage of $85,000.
Primary Care See details
The Clever Care Longevity (HMO) plan's Primary Care benefit 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, but does not cover routine chiropractic care and podiatry services. Individual and group sessions for mental health and psychiatric services, as well as opioid treatment program services, have a copay of $40. Occupational therapy, physical therapy, and speech-language pathology services have no copay and no coinsurance.
Preventive Services See details
The Clever Care Longevity (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services, with the latter having a copay for remote access technologies and a maximum benefit coverage amount for fitness benefits. Some services like health education, in-home safety assessment, and others are not covered. Other covered services include personal emergency response systems, alternative therapies (up to 24 visits), and fitness benefits (memory fitness).
Hearing Services See details
The Clever Care Longevity (HMO) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with prior authorization. The plan covers prescription hearing aids up to $600 per year per ear, 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 and eyewear. Eye exams require prior authorization and include one routine eye exam per year. Eyewear has a combined maximum benefit of $200 per year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Clever Care Longevity (HMO) plan covers a maximum of $550 every three months for dental services, with oral exams covered for 2 visits per year, dental x-rays for 1 visit per year, and prophylaxis (cleaning) and fluoride treatments covered for 2 and 1 visit per year, respectively. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 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 benefits are covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetics/Medical Supplies with a coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under the Clever Care Longevity (HMO) plan, with no copay. 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%.
Home Health Services See details
Home Health Services are covered by Clever Care Longevity (HMO), with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor's referral are required for covered services.
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, 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 of $1900 per year, and over-the-counter (OTC) items with a maximum benefit of $225 every three months. The plan also covers a meal benefit for chronic illnesses, and requires prior authorization and a doctor referral. Several other services are not covered, including Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more.
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