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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 a $590.00 deductible for prescription drugs. During the initial coverage phase, after you meet your deductible, you will pay 25% coinsurance for most drugs, but no copay for specialty tier drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $18.40. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Clever Care Total+ (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient and outpatient services, along with emergency, primary care, preventive, hearing, vision, and dental services, are included. Many services have a coinsurance of 20%, while emergency services have a copay of $95 for emergencies and $25 for urgently needed services. The plan also provides coverage for ambulance, transportation, and home health services, with some services having no copay. Additional benefits include coverage for medical equipment, dialysis, and other services like acupuncture and over-the-counter items. However, some services like cardiac rehabilitation and certain types of hearing aids and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits with the Clever Care Total+ (HMO C-SNP) plan include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, though some sub-services such as Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute has no copay.
Outpatient Services See details
Outpatient Services are covered by the Clever Care Total+ (HMO C-SNP) plan, including 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, while individual and group sessions for outpatient substance abuse also have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, 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. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation services to a plan-approved health-related location are covered for 24 one-way trips per year, and transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Clever Care Total+ (HMO C-SNP) plan. Emergency Services have a $95 copay and no coinsurance, Urgently Needed Services have a $25 copay and no coinsurance, and Worldwide Emergency Services have a maximum plan 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, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, 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 and podiatry services have a 20% coinsurance for routine care. Mental health specialty services, psychiatric services, and opioid treatment program services have a minimum 20% coinsurance.
Preventive Services See details
The Clever Care Total+ (HMO C-SNP) plan covers preventive services with no copay for Medicare-covered services, and other services like annual physical exams. Additional preventive services are covered with coinsurance, and some services such as health education and in-home safety assessments are not covered.
Hearing Services See details
Hearing Services are covered by the Clever Care Total+ (HMO C-SNP) plan, including hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams are limited to one per year, fitting/evaluation for hearing aids are limited to three per year, and prescription hearing aids (all types) are limited to one per year per ear with a maximum benefit of $600 per year per ear. OTC hearing aids are covered up to a maximum of $200 every three months for both ears combined. Prescription hearing aids - 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, with no copay or coinsurance. Eyewear is covered up to a combined maximum 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 are covered, with a maximum benefit 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, but orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 is covered by the Clever Care Total+ (HMO C-SNP) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Clever Care Total+ (HMO C-SNP). Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, and Diagnostic Procedures/Tests are not covered.
Home Health Services See details
Home Health Services are covered by the Clever Care Total+ (HMO C-SNP) plan with no copay and no coinsurance; however, 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 Clever Care Total+ (HMO C-SNP). Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the cost-sharing details are not provided in the snippet. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture, which is covered with a maximum plan benefit coverage amount of $2000 per year, and over-the-counter (OTC) items, which are covered up to $200 every three months and include nicotine replacement therapy (NRT) and Naloxone. Meal benefits are also covered, but require prior authorization and a doctor's referral. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services are not covered.
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