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Clover Health Classic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Clover Health Classic (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Clover Health Classic (HMO) in 2026, please refer to our full plan details page.
Clover Health Classic (HMO) is a HMO plan offered by Clover Health Holdings, Inc. available for enrollment in 2025 to people living in Select NJ Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Clover Health Classic (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 Clover Health Classic (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 Clover Health Classic (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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 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 Clover Health Classic (HMO) features a $0 drug deductible, allowing your prescription coverage to begin immediately. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard three-month mail order. This ensures that everyday, essential medications remain highly affordable for members. For Tier 3 preferred brand drugs, standard pharmacy copays range from $45 for a one-month supply up to $135 for a three-month supply, which matches the standard three-month mail order cost. Tier 4 non-preferred drugs carry a copay of $100 for a one-month supply up to $300 for a three-month supply. Finally, Tier 5 specialty medications require a 33% coinsurance for all supply durations through standard pharmacies and mail order.
Additional Benefits
The Clover Health Classic (HMO) plan offers robust coverage with predictable copayments and mostly no coinsurance for core medical services. Routine care is highly affordable, featuring no copay for primary care visits or preventive services, and a low $10 copay for specialists. If you require emergency care, outpatient services, or inpatient hospital stays, you will generally pay set copays—such as $130 for emergency visits and $300 daily for the first six days of an acute hospital stay—with no coinsurance. This plan also includes valuable supplemental benefits like dental, vision, and hearing coverage, which feature low copays and up to a $1,250 annual dental limit. For specialized needs, home health services and diabetic equipment require no copay, while durable medical equipment and dialysis services carry a 20% coinsurance. Additionally, members can take advantage of an over-the-counter allowance of $100 every three months with no copay or coinsurance.
Inpatient Hospital See details
Clover Health Classic (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 to 6 of acute stays and a $245 daily copay for days 1 to 6 of psychiatric stays, followed by no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Clover Health Classic (HMO) with no coinsurance, featuring a $275 copay for outpatient hospital and observation services, a $150 copay for ambulatory surgical center visits, and a $25 copay for individual or group substance abuse sessions. Outpatient blood services are also fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Clover Health Classic (HMO) plan with a $60.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Clover Health Classic (HMO) covers Medicare-covered ground and air ambulance services with a $350 copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by Clover Health Classic (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency services are covered up to a $50,000 maximum with no coinsurance and copays of $130 for emergency care, $40 for urgent care, and $350 for emergency transportation.
Primary Care See details
Clover Health Classic (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $10 copay and no coinsurance. Additional benefits like therapy, mental health, and telehealth feature copays ranging from $0 to $25 with no coinsurance, while podiatry is not covered and chiropractic services have some services covered but routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Clover Health Classic (HMO) with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and glaucoma screenings. While memory fitness and remote access technologies are included, sub-services such as health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Clover Health Classic (HMO) partially covers hearing services, offering routine hearing exams with a $10 copay and no coinsurance, and prescription hearing aids with a $499 to $999 copay and no coinsurance. Fitting and evaluation services are covered, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Clover Health Classic (HMO), offering one routine eye exam per year for a $10 copay and no coinsurance, with no deductible. Eyewear is covered with no copay, no coinsurance, and a $200 annual maximum for one pair of contact lenses or eyeglasses (lenses and frames) per year, though separate eyeglass lenses, frames, upgrades, and other eye exams are not covered.
Dental Services See details
Clover Health Classic (HMO) partially covers dental services up to a $1,250 yearly maximum, though orthodontics is not covered. Preventive and diagnostic services have no copay and no coinsurance, while Medicare-covered dental has a $10 copay and no coinsurance. Comprehensive services require a $30 copay and no coinsurance, except for removable prosthodontics which has no copay and 50% coinsurance.
Home Infusion bundled Services See details
Clover Health Classic (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Clover Health Classic (HMO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Clover Health Classic (HMO) with no copays, featuring a 20% coinsurance for durable medical equipment and prosthetics which require prior authorization. Diabetic equipment has no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Clover Health Classic (HMO) with no coinsurance, though prior authorization is required. There is no copay for lab services, while outpatient X-rays have a $30 copay, diagnostic procedures range from a $0 to $175 copay, and diagnostic and therapeutic radiological services require minimum copays of $50 and $60, respectively.
Home Health Services See details
Clover Health Classic (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Clover Health Classic (HMO) offers Cardiac Rehabilitation Services with no copay and no coinsurance, but in practice, only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Clover Health Classic (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Clover Health Classic (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $100 every three months via reimbursement. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this plan.
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