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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'll pay different copays or coinsurance amounts based on the drug tier and pharmacy. For example, you will have no copay for preferred generic drugs and specialty tier drugs at standard pharmacies. For standard generic drugs, you will pay a $47 copay, and for preferred brand drugs, you will pay a $99 copay. 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 variety of benefits with varying costs. You can expect a $150 copay for inpatient psychiatric hospital stays (days 1-7), while other inpatient services and home health services have no copay. Emergency Services have a $90 copay, which is waived if admitted to the hospital within 72 hours. This plan covers a range of outpatient services, including substance abuse treatment, with a $40 copay for individual and group sessions. It also includes coverage for ambulance and transportation services, preventive services, and home infusion services. Additionally, the plan offers dental, vision, and hearing services, along with coverage for medical equipment and some diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. For outpatient substance abuse individual and group sessions, there is a copay of $40.00.
Partial Hospitalization See details
Partial Hospitalization is covered by Clever Care Longevity (HMO), but requires prior authorization and a doctor's referral. The copay and coinsurance for this benefit are not described in this summary.
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 any health-related location are covered for 24 one-way trips per year using a bus/subway or other method.
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. Emergency Services have a $90 copay with no coinsurance, and the copay is waived if admitted to the hospital within 72 hours. Worldwide Emergency Services have a maximum plan benefit coverage of $85,000.
Primary Care See details
Clever Care Longevity (HMO) covers primary care physician services, occupational therapy services, physician specialist services, mental health specialty services, psychiatric services, physical therapy, and speech-language pathology services with no coinsurance. Individual and group sessions for mental health and psychiatric services have a $40 copay. Chiropractic services, other health care professional services, opioid treatment program services, and physical therapy and speech-language pathology services require prior authorization and a doctor referral. 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, with additional preventive services that may have a copay. Additional benefits include personal emergency response systems, alternative therapies (24 visits), and fitness benefits for memory fitness, up to $225 every three months. Remote access technologies have a copay ranging from $0 to $40. Some services, like health education and counseling services, are not covered.
Hearing Services See details
The Clever Care Longevity (HMO) plan covers 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 annually, as well as OTC hearing aids with a maximum benefit of $225 every three months for both ears combined. Prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services are covered, including routine eye exams once per year. Eyewear is also covered, with a combined maximum plan benefit coverage of $200 per year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames and upgrades.
Dental Services See details
Clever Care Longevity (HMO) covers a maximum of $550.00 for dental services every three months, including oral exams (2 per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), other preventive dental services, and orthodontic services. Restorative services, endodontics, periodontics, prosthodontics, removable, implant services, prosthodontics, fixed, oral and maxillofacial surgery are covered, but have limits on the number of visits per year or lifetime. 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 between 0% and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Clever Care Longevity (HMO) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Clever Care Longevity (HMO) plan, with no copay. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Some Diabetic Equipment services are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Clever Care Longevity (HMO), with no copay for some services, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered. Therapeutic Radiological Services are covered with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Clever Care Longevity (HMO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but specific services like Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clever Care Longevity (HMO) plan, but require 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 are not covered.
Other Services See details
The Clever Care Longevity (HMO) plan covers acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered with a maximum benefit of $1900 per year, and OTC items are covered up to $225 every three months; the meal benefit requires prior authorization and a doctor's referral.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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