Paying for Care

How much does it cost to have Clover?

Clover's plans vary in price. Some are paid for entirely by Medicare, funded by the taxes you've paid while working and by the money you pay in your Part B premium directly to Medicare. Other Clover plans charge members a monthly premium in addition to the funds Medicare has set aside for you, in exchange for richer benefits and lower cost for services.

We understand that cost is a factor in your health care choices. The total amount you'll spend on your health care goes beyond monthly premiums. What you pay in copays and co-insurance when you receive care and at the pharmacy can be a big part of your financial responsibility. To estimate your costs more accurately, check our formulary to learn your share of the cost of each of your medications. You can also learn the cost shares for the medical services you use in your Evidence of Coverage. It's okay to ask a provider to estimate your financial responsibility.


What's the difference between a copay and co-insurance?

Copayments and co-insurance are two different kinds of cost shares that our plans use to define your financial responsibility for covered services or items. A copay, or copayment, is a fixed amount of money that you pay for a covered benefit. Your plan pays the remainder of the cost. Co-insurance is the percentage of the total cost of a covered service or item that you pay. Your plan pays the rest of the cost.

What is an Explanation of Benefits?

An Explanation of Benefits is the activity history for claims submitted by your doctors or other providers to Clover. An explanation of benefits is not a bill, it's a notifications of claims that have been submitted to Clover that are paid or unpaid. If a claim is no paid, don't be alarmed, a provider may need to resubmit the claim before it's paid. If you receive a bill directly from the provider asking for payments please contact Member Service and we can clarify whether the bill is your responsibility or not.

Is there a way to reduce my health care costs?

Extra help is available to Medicare beneficiaries who need assistance paying for care. We're happy to help you learn more about what's available. Depending on your circumstances, Medicare Low Income Subsidy (LIS), State Pharmaceutical Assistance Programs, discount programs, Medicaid, and state premium assistance programs like SLMB can all help lower your costs. Contact Member Services to learn what's available in your area and how to apply.