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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 deductible of $590.00. In the initial coverage phase, after you pay the deductible, you will pay 25% coinsurance for most drugs, regardless of whether you use a preferred or standard pharmacy. However, the specialty tier drugs have no copay. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Clever Care Total+ (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. You can expect no copay for preventive services, annual physical exams, home health services, and transportation services (up to 24 one-way trips). Other services such as emergency services, outpatient services, primary care, and hearing services, come with either a copay or coinsurance, typically around 20%. This plan covers inpatient hospital stays, outpatient services, and partial hospitalization. It also includes dental, vision, and hearing services with specific coverage limits. Additional benefits include coverage for medical equipment, home infusion, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute has no copay.
Outpatient Services See details
Outpatient Services are covered under the Clever Care Total+ (HMO C-SNP) plan, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services, Observation Services, and Outpatient Blood Services have a 20% coinsurance, and Outpatient Substance Abuse services including individual and group sessions have a coinsurance of 20% as well.
Partial Hospitalization See details
Partial Hospitalization is covered under the Clever Care Total+ (HMO C-SNP) plan, requiring prior authorization and a doctor referral. The plan includes a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered with a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $95 copay and no coinsurance, while Urgently Needed Services have a $25 copay and no coinsurance; Worldwide Emergency Services coverage has a maximum benefit 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 services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance. Chiropractic services, mental health, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services also have a 20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
The Clever Care Total+ (HMO C-SNP) plan covers preventive services, including Medicare-covered zero-dollar preventive services and annual physical exams with no copay. Additional preventive services, Kidney Disease Education Services, Alternative Therapies, Remote Access Technologies, and Fitness Benefit are covered with coinsurance between 0% and 20%.
Hearing Services See details
The Clever Care Total+ (HMO C-SNP) plan covers hearing exams and prescription hearing aids with prior authorization, as well as routine hearing exams and fitting/evaluation for hearing aids; there is a limit of one routine hearing exam and three fitting/evaluation visits per year. This plan also covers OTC hearing aids, up to $200 every three months. Prescription hearing aids (all types) are covered up to $600 per year per ear, but hearing aids for the inner, outer, 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 and eyewear, with no deductible. Eyewear has a combined maximum benefit of $200 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and maxillofacial prosthetics are covered. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Clever Care Total+ (HMO C-SNP), and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Clever Care Total+ (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by Clever Care Total+ (HMO C-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Diabetic Supplies have a 20% coinsurance, and there is no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for lab services, with a coinsurance of at most 20%, and for diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, each with a coinsurance of at most 20%. Diagnostic procedures/tests are not covered.
Home Health Services See details
Home Health Services are covered 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 by the Clever Care Total+ (HMO C-SNP) plan. Prior authorization and a doctor's referral are required if the services were covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required, and the plan charges the Medicare-defined cost share for tier 1, but the copay information is not provided.
Other Services See details
The Clever Care Total+ (HMO C-SNP) plan covers acupuncture with a maximum benefit of $2,000 per year, and it covers over-the-counter (OTC) items up to $200 every three months, including nicotine replacement therapy and Naloxone. The plan also provides a meal benefit for chronic illnesses, but other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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