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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.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Clever Care Total+ (HMO C-SNP) is a HMO C-SNP plan offered by Clever Care Health Plan, Inc. available for the 2025 plan year 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
Health deductible: information not available.
This plan has a $590.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9350.00 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. After the deductible, you will pay 25% coinsurance for most drugs, with no copay for specialty tier drugs. Once your total drug costs reach $2000.00, you will 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, including coverage for inpatient and outpatient services, with varying cost-sharing. Emergency services come with a $95 copay, while urgently needed services have a $25 copay, and worldwide emergency services have a maximum coverage of $100,000. Many services, such as primary care, outpatient services, and ambulance services, have a 20% coinsurance. The plan also includes coverage for preventive, hearing, vision, and dental services, with specific limits and cost-sharing. Hearing aids have an annual allowance, while vision care includes routine eye exams and eyewear benefits. Dental services cover a range of procedures, and orthodontics has a maximum benefit. Additionally, the plan covers home health services with no copay and no coinsurance, and it offers an OTC allowance and acupuncture benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the Clever Care Total+ (HMO C-SNP) plan, but the specific cost-sharing details like copays and deductibles are not provided. Additional Days for Inpatient Hospital-Acute are covered with no copay, while 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 Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services, Observation Services, and Outpatient Blood Services have a 20% coinsurance, while Individual and Group Sessions for Outpatient Substance Abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under the Clever Care Total+ (HMO C-SNP) plan, but requires prior authorization and a doctor's referral. You will be responsible for a 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. All ambulance services, including ground and air ambulance services, are covered with a 20% coinsurance; there is no copay. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year via bus/subway or other means, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Clever Care Total+ (HMO C-SNP) plan. Emergency Services have a $95 copay and no coinsurance, while Urgently Needed Services have a $25 copay and no coinsurance. 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 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. Primary Care Physician Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services have a 20% coinsurance. Chiropractic, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services 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 annual physical exams. Additional preventive services are covered with coinsurance, and other services like health education, in-home safety assessments, medical nutrition therapy, and others are not covered.
Hearing Services See details
The Clever Care Total+ (HMO C-SNP) plan covers hearing exams, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (3 per year). Prescription hearing aids are covered up to $600 per year per ear, while OTC hearing aids are covered up to $200 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. Eyewear is covered with a combined maximum benefit of $200 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, other preventive services, and orthodontics with a maximum benefit of $550 every three months. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and orthodontics are partially covered, and maxillofacial prosthetics and oral and maxillofacial surgery are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, you will pay a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor referral. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices, Medical Supplies, and Diabetic Supplies/Shoes/Inserts also have a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Clever Care Total+ (HMO C-SNP) plan. Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while 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, but 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 not covered by Clever Care Total+ (HMO C-SNP). Prior authorization and a doctor's referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Clever Care Total+ (HMO C-SNP) plan, but require prior authorization and a doctor's referral. The plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays.
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 include nicotine replacement therapy and Naloxone. The plan also covers a meal benefit for a chronic illness, but requires prior authorization and a doctor's referral. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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