A non-government entity
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 2026, 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 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 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 $0.00. 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 $615.00 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 $9250.00 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:
Sign up for Clever Care Total+ (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Clever Care Total+ (HMO C-SNP) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a 10% coinsurance for Tier 1 preferred generic drugs and a 25% coinsurance for Tiers 2 through 4 at standard pharmacies or standard mail. There is no copay for Tier 5 specialty drugs during this initial coverage phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Additionally, beneficiaries who qualify for the low-income subsidy (LIS) can lower their costs, paying $0.00 for their Part D premium.
Additional Benefits
The Clever Care Total+ (HMO C-SNP) plan offers comprehensive coverage where many outpatient services, specialist visits, and medical equipment require no copay and a 20% coinsurance. Members can access routine preventive care, annual physicals, and eye exams with no copay or deductible. Emergency room visits require a $95 copay, which is waived if admitted to the hospital within 72 hours, while urgent care services carry a $25 copay. In addition to core medical coverage, this plan provides valuable supplemental benefits to support daily wellness. Members benefit from up to 48 one-way transportation trips per year to approved locations, a $1,200 semi-annual dental limit, and a $350 annual eyewear allowance. The plan also features unlimited acupuncture treatments up to a $2,000 annual limit and covers unlimited over-the-counter hearing aids.
Inpatient Hospital See details
Clever Care Total+ (HMO C-SNP) offers partially covered inpatient hospital services subject to Medicare-defined copays and coinsurance, requiring prior authorization and doctor referrals. While unlimited additional days for acute care are covered, upgrades, non-Medicare-covered stays, and additional days or non-Medicare-covered stays for psychiatric care are not covered.
Outpatient Services See details
Clever Care Total+ (HMO C-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required for these covered benefits.
Partial Hospitalization See details
Partial hospitalization is covered by Clever Care Total+ (HMO C-SNP) with a 20% coinsurance and no copay. These services require prior authorization and, in some instances, a doctor referral.
Ambulance and Transportation Services See details
Clever Care Total+ (HMO C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Clever Care Total+ (HMO C-SNP) covers emergency services with a $95 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 72 hours. Urgently needed services are covered with a $25 copay and no coinsurance, and worldwide emergency services are covered up to a maximum benefit limit of $100,000.
Primary Care See details
Primary care and specialist services are covered by Clever Care Total+ (HMO C-SNP), with most therapy, psychiatric, and specialty services requiring a 20% coinsurance and no listed copay. Chiropractic services are partially covered, as routine chiropractic care is not covered.
Preventive Services See details
Clever Care Total+ (HMO C-SNP) partially covers Preventive Services, offering Medicare-covered zero-dollar preventive care and annual physicals with no copay or coinsurance, while kidney disease education requires 20% coinsurance. Specific sub-services such as health education, therapeutic massage, weight management, and nutritional benefits are not covered.
Hearing Services See details
Clever Care Total+ (HMO C-SNP) offers partially covered hearing services with no deductible, including routine exams, fitting evaluations, and unlimited OTC hearing aids. While prescription hearing aids are covered up to $600 per ear annually, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Clever Care Total+ (HMO C-SNP) with no deductible, including one routine eye exam per year with prior authorization. The plan also provides a $350 annual maximum benefit for eyewear, covering upgrades and one pair of contacts or eyeglasses per year.
Dental Services See details
Dental services are partially covered under the Clever Care Total+ (HMO C-SNP) plan, which features a maximum benefit of $1,200 every six months for diagnostic and preventive care. While specific copays and coinsurance are not specified, prior authorization is required for most advanced dental procedures, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Clever Care Total+ (HMO C-SNP) covers home infusion bundled services with prior authorization, including insulin, chemotherapy, and other Part B drugs. Covered insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Clever Care Total+ (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these services.
Medical Equipment See details
Clever Care Total+ (HMO C-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by Clever Care Total+ (HMO C-SNP) with no copay and a 20% coinsurance for covered services. While lab work, X-rays, and radiological services are covered, diagnostic procedures and tests are not covered.
Home Health Services See details
Home Health Services are covered by Clever Care Total+ (HMO C-SNP), requiring prior authorization and a doctor referral, though specific copay and coinsurance information is not provided.
Cardiac Rehabilitation Services See details
Clever Care Total+ (HMO C-SNP) does not provide coverage for Cardiac Rehabilitation Services, as all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered. Because these services are not covered in practice, there are no associated copays or coinsurance costs for members.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Clever Care Total+ (HMO C-SNP), as additional days beyond the Medicare-covered limit are not covered. This benefit requires prior authorization and a doctor referral, with cost-sharing based on Medicare-defined copays and coinsurance.
Other Services See details
Other Services are partially covered under Clever Care Total+ (HMO C-SNP), offering unlimited acupuncture treatments up to a $2,000 annual limit and over-the-counter items via reimbursement, though specific copay and coinsurance details are not specified. Meal benefits and dual eligible SNPs with highly integrated services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved