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Clever Care Total+ (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clever Care Total+ (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clever Care Total+ (HMO C-SNP) in 2025, please refer to our full plan details page.
Clever Care Total+ (HMO C-SNP) is a HMO C-SNP 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 Total+ (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Clever Care Total+ (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Clever Care Total+ (HMO C-SNP).
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 Total+ (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.40. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 Total+ (HMO C-SNP) plan has an enhanced alternative drug benefit. The plan has a $590 deductible. After you meet your deductible, you will pay 25% coinsurance for most drugs, but specialty tier drugs have no copay. 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 Total+ (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays for acute care have no copay, while outpatient services and partial hospitalization have a 20% coinsurance. Emergency services have a $95 copay, and urgently needed services have a $25 copay. This plan covers primary care, preventive services, hearing, vision, and dental services with specific copays, coinsurance, and maximum benefits. The plan also covers ambulance services with no copay, and transportation services for health-related appointments. Additional benefits include medical equipment, home health services, and other services like acupuncture and over-the-counter items, all with specific cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute have no copay.
Outpatient Services See details
Outpatient Services are covered under the Clever Care Total+ (HMO C-SNP) plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Clever Care Total+ (HMO C-SNP) plan, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Clever Care Total+ (HMO C-SNP) plan, with no copay for ambulance services. Ground and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for 24 one-way trips per year via bus/subway or other transportation methods. Transportation services to any health-related location are 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 by Clever Care Total+ (HMO C-SNP). Emergency Services have a $95 copay and no coinsurance, while Urgently Needed Services have a $25 copay and no coinsurance. Worldwide Emergency Services has a maximum benefit coverage of $100,000.
Primary Care See details
The Clever Care Total+ (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. These services have a 20% coinsurance, and chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, and opioid treatment program services require a doctor referral and prior authorization. Routine chiropractic care is not covered.
Preventive Services See details
The Clever Care Total+ (HMO C-SNP) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are covered with coinsurance, as are Kidney Disease Education Services, which require a doctor's referral and have a 20% coinsurance. Services like Health Education and many others are not covered.
Hearing Services See details
The Clever Care Total+ (HMO C-SNP) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with 1 routine hearing exam and 3 fitting/evaluation visits per year. Prescription hearing aids are covered with a maximum benefit of $600 per ear every year, while OTC hearing aids are covered with a maximum benefit of $200 for both ears combined every three months. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Clever Care Total+ (HMO C-SNP) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit coverage of $550 every three months. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered with limitations. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Clever Care Total+ (HMO C-SNP). 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 Total+ (HMO C-SNP) plan, but require prior authorization and a doctor's referral. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered, with a 20% coinsurance for Durable Medical Equipment, Medicare-covered Prosthetic Devices, and Medicare-covered Medical Supplies. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests are not covered. Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and there is no copay.
Home Health Services See details
Home Health Services are covered by Clever Care Total+ (HMO C-SNP) 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 not covered under the Clever Care Total+ (HMO C-SNP) plan. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. A doctor referral and prior authorization are required, and the plan charges the Medicare-defined cost share for tier 1.
Other Services See details
The Clever Care Total+ (HMO C-SNP) plan covers acupuncture with a maximum benefit of $2,000 per year. Over-the-counter (OTC) items are covered with a maximum benefit of $200 every three months, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit. The plan's meal benefit requires prior authorization and a doctor referral, and is for a chronic illness, with no maximum plan benefit coverage amount. However, services such as 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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