Eligibility and Enrollment

Can I enroll in a Clover plan?

Clover is a Medicare Advantage plan. To enroll, you must have Medicare Part A and Medicare Part B, and you must live in one of the counties we serve. You can't enroll with Clover if you have End Stage Renal Disease, or if you're undergoing dialysis.
 

How much does a Clover plan cost?

Visit our website here and enter your ZIP code for a description of all the plans available in your area, including costs and benefits. Remember that any Clover plan premiums are in addition to the Part B premium you pay to participate in Medicare. Additional assistance like Low Income Subsidy (LIS), or a State Pharmaceutical Assistance Program (SPAP) can reduce the amount you pay.
 

What is a Medicare Advantage plan and how is it different from Original Medicare?

If you're eligible for Medicare, your providers can bill Medicare directly for the care you receive. This is called Original Medicare. You can also choose to enroll in a plan that administers the benefits Medicare covers. Medicare Advantage (MA) plans are commercial plans that administer your Medicare Part A and Part B benefits. Some Medicare Advantage plans, like Clover, include a Part D benefit. Medicare Advantage, or Part C plans specify the ways in which their members can access care, but they also often cover things that Original Medicare does not. MA plans also have a limit to the total amount you can pay for your care in a year. Clover's out-of-pocket maximum is $6,700.

What county you live in determined what MA plans are available to you. Some plans assist with additional costs beyond what's covered by Medicare. Some plans are fully paid for by money received from Medicare, while others require members to pay a monthly premium.
 

Can I join or leave the plan at any time?

Medicare places some restrictions on how beneficiaries can join and leave Medicare Advantage plans. These rules are common across all Medicare Advantage (MA) plans. There is a yearly Annual Enrollment Period (AEP) from October 15 to December 7 when all beneficiaries may join an MA plan, or switch plans. There is also an Medicare Annual Disenrollment Period (MADP) from January 7 to February 15 when all beneficiaries can leave their MA plan and return to Original Medicare. Outside of these periods, beneficiaries can only change plans under certain circumstances. Under these circumstances, members are qualified for a Special Enrollment Period (SEP), during which they may change plans or enroll in a new plan.
 

Who can help me enroll in a Clover plan?

To enroll, contact our Enrollment team at the number on the bottom of the page. Our plans are also sold by independent brokers. We rely on our telesales team and these independent brokers to present our plans accurately and to assist you in finding the best coverage for your unique circumstances. Please feel free to reach out to Member Services and share any comments you may have about the enrollment process.
 

How do I disenroll?

Before you go, our Member Services team would like to help resolve any issues that may be preventing you from getting the most from your plan. Contact us, and we're happy to help with issues including accessing care, paying for care, and more.

If you do choose to disenroll from Clover, you can initiate the process of disenrollment by notifying us in writing (hand written or typed letter that you sign) that you want to leave the plan. Member Services can send you a form to facilitate this process, and can confirm whether you have a valid SEP to leave the plan. Medicare must approve all disenrollments before they are final, and will verify that you have a valid SEP. If you don't have a valid SEP, Medicare may not approve your request to leave the plan.

If you leave Clover with a valid SEP to return to Original Medicare or to a plan without Part D coverage, it's important to make other arrangements for your Part D coverage within 60 days of disenrollment. If you have any months without Part D, you may pay a penalty.
 

Can I use Clover with other insurance?

Yes. If your provider agrees to work with both Clover and your other health insurance plan, you may pay less for your benefits than with only one coverage. If you have more than one plan, each may cover a different set of services and have its own requirements for network, authorization, and referral. Each plan operates separately, and has its own rules and policies that govern how care is administered. For a service to be covered by more than one plan, it has to be requested and performed in accordance with the network, authorization, and referral requirements all the plans who will be billed.

You're responsible for bringing evidence of all coverages to all appointments and to the pharmacy to get the benefits of all the plans. Your provider is responsible for billing each insurance correctly. If you ever receive a bill for a service that you think should be covered differently, please contact us for assistance.

 

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