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Clever Care Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clever Care Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clever Care Value (HMO) in 2025, please refer to our full plan details page.
Clever Care Value (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 Value (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 Value (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 Value (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 $110.00. 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 $2900.00 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 Value (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions, which varies depending on the drug tier and the pharmacy you use. For example, generic drugs have a $5 copay at standard mail pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Clever Care Value (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and emergency services. You'll also find coverage for primary care, preventive services, hearing, vision, and dental services. The plan provides additional benefits like transportation services, medical equipment, and home health services. You can also get coverage for other services, such as acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits for the Clever Care Value (HMO) plan include coverage for Inpatient Hospital-Acute with a $100 copay for days 1-5 and no copay for days 6-90, as well as Inpatient Hospital Psychiatric with a $175 copay for days 1-7 and no copay for days 8-90; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services and ambulatory surgical center services have a $75 copay, while individual and group sessions for outpatient substance abuse each have a $40 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Clever Care Value (HMO) plan, but requires both prior authorization and a doctor referral. There is no information about the cost of these services in the provided snippet.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clever Care Value (HMO) plan. Ground ambulance services have a $200 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location include 16 one-way trips per year via bus/subway or other transportation.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, with no coinsurance, and the copay is waived if you are admitted to the hospital within 72 hours. Worldwide Emergency Services have a maximum plan benefit coverage amount of $55,000.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered. Chiropractic Services have a $5 copay, but routine care is not covered. Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions. Opioid Treatment Program Services have a 20% coinsurance. Podiatry Services are not covered. Other Health Care Professional services have a copay from $0 to $40.
Preventive Services See details
Preventive services are covered under the Clever Care Value (HMO) plan, including Medicare-covered preventive services and annual physical exams. Additional preventive services are covered, with a copay for remote access technologies ranging from $0 to $40; other services like health education, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids are limited to three per year. Prescription hearing aids are covered up to $600 per year per ear, and OTC hearing aids are covered up to $50 every three months. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include coverage for routine eye exams with no deductible, offering one exam every year, and eyewear with a combined maximum benefit of $200 every year, as well as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Prior authorization is required for eye exams.
Dental Services See details
The Clever Care Value (HMO) plan covers dental services, including oral exams and dental x-rays with a maximum benefit of $200 every three months. Other services like prophylaxis (cleaning) and fluoride treatments are also covered with limitations on the number of visits and periodicity, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Clever Care Value (HMO) plan, with a $35 copay for Medicare Part B Insulin Drugs, and coinsurance ranging from 0-20% for all services. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Clever Care Value (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 under the Clever Care Value (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. Prosthetics/Medical Supplies - Non-Medicare benefits are covered with no copay, and Diabetic Equipment has a coinsurance for Medicare-covered Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Clever Care Value (HMO), but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. For Diagnostic Radiological Services, there is a copay of at most $75, and for Therapeutic Radiological Services, there is a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Clever Care Value (HMO) plan with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Clever Care Value (HMO), but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clever Care Value (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Clever Care Value (HMO) plan, acupuncture is covered with a maximum plan benefit coverage amount of $1000 per year, and over-the-counter items are covered up to $50 every three months, including nicotine replacement therapy and Naloxone. The plan also covers meal benefits for chronic illnesses, but many other services are not covered.
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