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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. In the initial coverage phase, after you meet your deductible, you will pay 25% coinsurance for most drugs. However, there is no copay for specialty tier drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Clever Care Total+ (HMO C-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services with varying coinsurance amounts. You can expect no copays for preventive services, hearing exams, routine eye exams, and home health services. There are also additional benefits like coverage for dental, vision, and hearing services, with allowances for eyewear, hearing aids, and dental procedures. The plan also covers emergency services with a copay, as well as ambulance and transportation services with coinsurance. You'll find coverage for several other services like diagnostic and radiological services, medical equipment, and some additional therapies. However, the plan does not cover certain services, such as cardiac rehabilitation, additional hours of care, and some other specific services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, though Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and 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, 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 Outpatient Substance Abuse Services, including individual and group sessions, have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial hospitalization is covered by Clever Care Total+ (HMO C-SNP), 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 up to 24 one-way trips per year. 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 by the Clever Care Total+ (HMO C-SNP) plan. Emergency Services have a $95 copay and no coinsurance, and Urgently Needed Services have a $25 copay and no coinsurance. Worldwide Emergency Services are covered up to a maximum of $100,000.
Primary Care See details
The Clever Care Total+ (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, specialist services, mental health 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, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, have a 20% coinsurance. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, Podiatry Services, Other Health Care Professional Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered. Routine Foot Care has a 20% coinsurance.
Preventive Services See details
Preventive Services are covered by Clever Care Total+ (HMO C-SNP), including Medicare-covered services with no copay. Additional preventive services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Alternative Therapies are covered, with a coinsurance of 20% for Kidney Disease Education Services and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline).
Hearing Services See details
The Clever Care Total+ (HMO C-SNP) plan covers hearing exams and routine hearing exams with no copay, and also covers fitting/evaluation for hearing aids, and prescription hearing aids up to $600 per year per ear. Additionally, OTC hearing aids are covered up to $200 every three months.
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 and no deductible, and eyewear with a combined maximum benefit of $200 per year, with no deductible. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services include coverage for Medicare Dental Services, Oral Exams (2 per year), Dental X-Rays (1 per year), Other Diagnostic Dental Services, Prophylaxis (Cleaning, 2 per year), Fluoride Treatment (1 per year), Other Preventive Dental Services, Restorative Services (1 per two years), Adjunctive General Services, Endodontics (1 per lifetime), Periodontics (1 per three years), Prosthodontics, removable (1 every 5 years), Maxillofacial Prosthetics, Implant Services (1 every 5 years), Prosthodontics, fixed (1 every 5 years), and Oral and Maxillofacial Surgery. This plan also offers Orthodontic Services, but the Orthodontics benefit is not covered. There is a maximum benefit of $550 every three months.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Clever Care Total+ (HMO C-SNP) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Clever Care Total+ (HMO C-SNP) plan, requiring prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance with prior authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies also have a 20% coinsurance, and Medical Supplies have a 20% coinsurance, all with no copay.
Diagnostic and Radiological Services See details
The Clever Care Total+ (HMO C-SNP) plan covers lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services with a coinsurance of at most 20%; however, diagnostic procedures/tests are not covered. There is no copay for these services.
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 require authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Clever Care Total+ (HMO C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. The plan charges the Medicare-defined cost share for tier 1, and more information about copays is available.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered up to $2,000 per year, while OTC items are covered up to $200 every three months, and the meal benefit requires prior authorization and a doctor referral. Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance 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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