Paying for Care
How much does it cost to have Clover Health?
The majority of Clover Health’s Medicare Advantage plans have no monthly plan premium, which means that after you pay your monthly Part B premium, there is no additional premium for you to pay. Your monthly Part B premium is paid directly to Medicare, usually through a deduction to your social security check.
We understand that cost is a factor in your healthcare choices. The total amount you'll spend on your healthcare goes beyond monthly premiums. What you pay in copays and coinsurance when you receive care and at the pharmacy can be a big part of your financial responsibility. To estimate your costs for each of your medications more accurately, check our formulary. 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.
We understand that cost is a factor in your healthcare choices. The total amount you'll spend on your healthcare goes beyond monthly premiums. What you pay in copays and coinsurance when you receive care and at the pharmacy can be a big part of your financial responsibility. To estimate your costs for each of your medications more accurately, check our formulary. 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 coinsurance 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. Coinsurance is the percentage of the total cost of a covered service or item that you pay. Your plan pays the rest.
What is an Explanation of Benefits?
An explanation of benefits (EOB) is the activity history for claims submitted to Clover Health by your doctors or other providers. An EOB is not a bill, it's a notification of claims that have been submitted to Clover Health that are paid or unpaid. If a claim is not 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 Services and we can clarify whether the bill is your responsibility or not.
Is there a way to reduce my healthcare 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, the Medicare Low-Income Subsidy (LIS), State Pharmaceutical Assistance Programs (SPAP), discount programs, Medicaid, and state premium assistance programs like SLMB can all help lower your costs. To learn what's available in your area and how to apply, contact Member Services at 1-888-778-1478 (TTY 711) 8 am–8 pm local time, 7 days a week.*