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Eligibility and Enrollment

Can I enroll in a Clover plan?

Clover Health 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.
 

How much does a Clover Health Medicare Advantage plan cost?

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

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 Health, include a Part D benefit. Medicare Advantage, or Part C plans, specify the ways in which their members can access care, but they often cover things that Original Medicare does not. MA plans also have a limit on the total amount you can pay for your care in a year. Clover Health’s out-of-pocket maximum is $7,550 or lower, depending on the plan.

The county you live in determines 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.

  • Annual Enrollment Period (AEP) from October 15th to December 7th – when all beneficiaries may join an MA plan. You can also change from:
    • One Medicare Advantage plan to another Medicare Advantage plan
    • Original Medicare or Medicare Supplement Insurance (Medigap) to a Medicare Advantage plan
    • A Medicare Advantage plan to Original Medicare
  • Open Enrollment Period (OEP) from January 1st to March 31st – when all beneficiaries can:
    • Switch to another Medicare Advantage plan
    • Leave their Medicare Advantage plan and return to Original Medicare (Parts A & B)

Note: If you have Original Medicare only, you cannot use the Open Enrollment Period to select a Medicare Advantage plan.

  • Initial Enrollment Period (IEP), the 7-month window when you can first sign up for Medicare Part A and/or Part B. For most, it’s when you turn 65/entitlement. The 7-month period includes:
    • 3 months before you turn 65/entitlement
    • The month you turn 65/entitlement
    • 3 months after you turn 65/entitlement

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 provided at the bottom of this 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. We're happy to help with issues including accessing care, paying for care, and more.

If you do choose to leave Clover Health, you can initiate the process of disenrollment by notifying us in writing (handwritten 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 Health 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 Health with other insurance?

Yes. If your provider agrees to work with both Clover Health and your other health insurance plan, you may pay less for your benefits than with only one form of 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 for all plans that 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 plan correctly. If you ever receive a bill for a service that you think should be covered differently, please contact Member Services for assistance at 1-888-778-1478 (TTY 711) 8 am–8 pm local time, 7 days a week.*

 

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