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Clever Care Breathe+ (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clever Care Breathe+ (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 Breathe+ (HMO C-SNP) in 2026, please refer to our full plan details page.
Clever Care Breathe+ (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 Breathe+ (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 Breathe+ (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 Breathe+ (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 Breathe+ (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:
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Drug Coverage
The Clever Care Breathe+ (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 25% coinsurance for Tier 1 through Tier 4 medications when using standard pharmacies or standard mail-order services. Notably, Tier 5 specialty drugs are covered with no copay at standard pharmacies and through standard mail delivery. These cost-sharing rates apply during the initial coverage phase until your total yearly out-of-pocket drug costs reach $2,100.00. Once you reach this $2,100.00 threshold, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs. Furthermore, beneficiaries who qualify for the low-income subsidy can reduce their Part D costs to $0.00.
Additional Benefits
The Clever Care Breathe+ (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, home health services, and most preventive care. For outpatient services, diagnostic tests, dialysis, and durable medical equipment, members generally pay no copay and a 20% coinsurance. Emergency room visits require a $95 copay, which is waived if you are admitted to the hospital, while urgent care services have a $25 copay. Supplemental benefits include dental coverage up to $1,200 every six months, as well as vision coverage with no deductible and a $350 annual eyewear allowance. Members also benefit from up to 48 one-way transportation trips to health-related locations each year and unlimited over-the-counter hearing aids with no deductible. Additionally, the plan covers acupuncture treatments up to a $2,000 annual limit and offers reimbursement for select over-the-counter items.
Inpatient Hospital See details
Clever Care Breathe+ (HMO C-SNP) partially covers inpatient hospital services, with costs based on Medicare-defined deductibles, copays, and coinsurance. While unlimited additional acute care days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Clever Care Breathe+ (HMO C-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these covered benefits.
Partial Hospitalization See details
Clever Care Breathe+ (HMO C-SNP) covers partial hospitalization benefits with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required for these services.
Ambulance and Transportation Services See details
Clever Care Breathe+ (HMO C-SNP) covers ambulance services with a 20% coinsurance and no copay. 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
Emergency services are covered by Clever Care Breathe+ (HMO C-SNP) with a $95 copay and no coinsurance, which is waived if you are admitted to the hospital within 72 hours. Urgently needed services require a $25 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a maximum benefit of $100,000.
Primary Care See details
Clever Care Breathe+ (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialized services like occupational therapy and psychiatric care require a 20% coinsurance and no copay. Chiropractic services are partially covered, as routine chiropractic care is not covered.
Preventive Services See details
Clever Care Breathe+ (HMO C-SNP) partially covers preventive services, with no copay and no coinsurance for most benefits, although kidney disease education requires no copay and a 20% coinsurance. Not covered under this benefit are in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, wigs, weight management, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional tobacco cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Clever Care Breathe+ (HMO C-SNP) covers hearing services with no deductible, including one routine hearing exam and three fitting evaluations annually, as well as unlimited OTC hearing aids. Prescription hearing aids are partially covered up to $600 per ear yearly, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Clever Care Breathe+ (HMO C-SNP) covers vision services with no deductible, including one routine eye exam and up to $350 for eyewear—such as contact lenses, frames, lenses, and upgrades—every year. Prior authorization is required for eye exams, and no copay or coinsurance details are specified for these covered services.
Dental Services See details
Clever Care Breathe+ (HMO C-SNP) partially covers dental services up to a maximum benefit of $1,200 every six months, though specific copay and coinsurance information is not specified. A wide range of preventive and comprehensive services are covered, but maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Clever Care Breathe+ (HMO C-SNP) and require prior authorization. Covered Medicare Part B Insulin Drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Clever Care Breathe+ (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive this benefit.
Medical Equipment See details
Medical equipment is covered by Clever Care Breathe+ (HMO C-SNP) with a 20% coinsurance and no copay. This benefit includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment, all of which require prior authorization.
Diagnostic and Radiological Services See details
Clever Care Breathe+ (HMO C-SNP) partially covers diagnostic and radiological services, though diagnostic procedures and tests are not covered. Covered services, including lab work, outpatient x-rays, and diagnostic or therapeutic radiological services, require a 20% coinsurance and no copay, and they require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by Clever Care Breathe+ (HMO C-SNP) with no copay and no coinsurance. Members are required to obtain prior authorization and a doctor referral to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Clever Care Breathe+ (HMO C-SNP) plan, as none of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered in practice.
Skilled Nursing Facility (SNF) See details
Clever Care Breathe+ (HMO C-SNP) partially covers skilled nursing facility (SNF) services, although additional days beyond the Medicare-covered limit are not covered. Prior authorization and a doctor referral are required, and your copay and coinsurance costs will follow Medicare-defined cost-sharing rates.
Other Services See details
Clever Care Breathe+ (HMO C-SNP) provides partial coverage for other services, which includes unlimited acupuncture treatments up to a $2,000 annual limit and reimbursement for over-the-counter items like nicotine replacement therapy and naloxone. Meal benefits and highly integrated services for dual-eligible SNPs are not covered under this plan.
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