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Clever Care Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clever Care Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clever Care Value (HMO) in 2026, please refer to our full plan details page.
Clever Care Value (HMO) is a HMO plan offered by Clever Care Health Plan, Inc. available for enrollment in 2026 to people living in Southern California. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Clever Care Value (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Clever Care Value (HMO).
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 Value (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $120.00. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2000.00 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 Value (HMO) plan features an Enhanced Alternative drug benefit with no prescription drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs and Tier 5 specialty tier drugs when using standard pharmacies or standard mail order. For other drug tiers, you will pay a $30 copay for Tier 2 standard generics, a $75 copay for Tier 3 preferred brands, or a 33% coinsurance for Tier 4 non-preferred drugs. These cost-sharing rates apply during the initial coverage phase until your total drug costs reach $2,100. After reaching this $2,100 limit in yearly out-of-pocket costs, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Individuals who qualify for the Low-Income Subsidy program may also see their Part D premium reduced to zero.
Additional Benefits
The Clever Care Value (HMO) plan offers affordable medical coverage with doctor and specialist copays ranging from no copay up to $25, alongside no copay for preventive services and urgent care. Emergency room visits require a $125 copay with no coinsurance, which is waived upon hospital admission. For inpatient hospital stays, members pay a $100 daily copay for days one through five, with no coinsurance and no copay for the remaining days. Additional benefits include a $200 annual allowance for eyewear and up to $400 every six months for preventive and comprehensive dental care. Hearing services feature no deductible and cover unlimited over-the-counter hearing aids, plus up to $600 annually per ear for prescription hearing aids. Members also benefit from up to 16 free one-way transportation trips per year and up to $1,000 annually for acupuncture services.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Clever Care Value (HMO) with no coinsurance, requiring a $100 daily copay for days 1 through 5 of acute care and a $175 daily copay for days 1 through 7 of psychiatric care, with no copay for remaining days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Clever Care Value (HMO) covers outpatient services, including outpatient hospital and ambulatory surgical center visits for a $75 copay, and outpatient substance abuse sessions for a $25 copay, with no coinsurance. Outpatient blood services are also covered with no deductible, though most of these services require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Clever Care Value (HMO) plan, though prior authorization and a doctor referral are required. Specific copay and coinsurance costs for these services are not specified in the plan details.
Ambulance and Transportation Services See details
Clever Care Value (HMO) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 16 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Clever Care Value (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services are covered with no copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a maximum benefit of $75,000.
Primary Care See details
Clever Care Value (HMO) covers primary care, specialist, and therapy services with copays ranging from $0 to $25 and no coinsurance, while opioid treatment requires a 20% coinsurance and no copay. Podiatry services are not covered, and chiropractic benefits are only partially covered because routine chiropractic care is excluded.
Preventive Services See details
Clever Care Value (HMO) covers Medicare preventive services with no copay, including annual physical exams and kidney disease education. Additional preventive benefits are partially covered, offering coverage for alternative therapies, fitness, and personal emergency response systems, while services like health education, therapeutic massage, and weight management are not covered.
Hearing Services See details
Hearing services are covered by Clever Care Value (HMO) with no deductible and no listed copays or coinsurance, including annual routine exams, fitting evaluations, and unlimited over-the-counter hearing aids. Prescription hearing aids are partially covered up to $600 per ear annually, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Clever Care Value (HMO) covers one routine eye exam per year and eyewear upgrades with no deductible. The plan also provides a $200 annual maximum benefit for eyewear, including contact lenses and eyeglasses.
Dental Services See details
Clever Care Value (HMO) partially covers dental services, excluding maxillofacial prosthetics and orthodontics. Covered benefits include preventive and comprehensive care up to a maximum of $400 every six months, though specific copayment and coinsurance amounts are not detailed.
Home Infusion bundled Services See details
Clever Care Value (HMO) covers Home Infusion bundled Services under prior authorization, offering Medicare Part B insulin drugs for a $35 copay and coinsurance ranging from no coinsurance to 20%. Other covered Part B drugs, such as chemotherapy and radiation, have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Clever Care Value (HMO) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these services.
Medical Equipment See details
Medical equipment is partially covered by Clever Care Value (HMO), as diabetic supplies are not covered under this plan. Covered items, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, require no copay and carry a coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Clever Care Value (HMO), requiring doctor referrals and prior authorization. Diagnostic services feature no copay, but diagnostic procedures, tests, and lab services are not covered; radiological services require a $0 to $75 copay for diagnostic services and 20% coinsurance for therapeutic services, while outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the Clever Care Value (HMO) plan, but require prior authorization and a doctor referral. Specific copay and coinsurance costs are not specified for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Clever Care Value (HMO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all not covered.
Skilled Nursing Facility (SNF) See details
Clever Care Value (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $210 daily copay for days 21 through 100. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Clever Care Value (HMO) partially covers Other Services, providing up to $1,000 annually for acupuncture and reimbursement for over-the-counter items. Meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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