Clover Health 2027 Plan
Choice PPO (004)
Medical & Rx drug coverage
An all-in-one plan that includes prescription drug coverage & the freedom to choose your PCP. Plus, allowances for dental, eyewear and OTC items.
Monthly Premium
$0
Primary Care Visit
$0
Maximum Out-of-Pocket
$9,850
General Costs
Monthly premium
$0
Medical deductible
$0
Maximum out-of-pocket
$9,850 in-network / $14,800 in- & out-of-network combined
Cost to See Your Doctor
In-Network
Out-of-Network
Primary Care visits
$0
$0
Specialist visits
$15
$30
Hospital Costs
In-Network
Out-of-Network
Inpatient hospital (days 1-6)
$408
$560
Emergency care
$115
$115
Urgent care
$35
$35
Outpatient labs (Labcorp or Quest)
$0
$0
Outpatient Labs: Other Vendors
$25
$50
Prescription Costs
Prices are for a 30-day supply from an in-network pharmacy.
Part D deductible
$350 Tiers 3-5
Tier 1
$0
Tier 2
$10
Tier 3
$47
Tier 4
31%
Tier 5
29%
Extra Benefits and Services
Clover plans include these important benefits and services. Original Medicare doesn't.
Part B Giveback (monthly)
Not included
Fitness benefit
Included
OTC allowance (quarterly)
$75
Routine dental, vision, & hearing exams
$0 in-network
Worldwide Coverage
Included
LiveHealthy Rewards
$400
Dental allowance (yearly)
$1,500
Eyewear allowance (yearly)
$300
General Costs
Monthly premium
$0
Medical deductible
$0
Maximum out-of-pocket
$9,850 in-network / $14,800 in- & out-of-network combined
Cost to See Your Doctor
In-Network
Out-of-Network
Primary Care visits
$0
$0
Specialist visits
$15
$30
Hospital Costs
In-Network
Out-of-Network
Inpatient hospital (days 1-6)
$408
$560
Emergency care
$115
$115
Urgent care
$35
$35
Outpatient labs (Labcorp or Quest)
$0
$0
Outpatient Labs: Other Vendors
$25
$50
Prescription Costs
Prices are for a 30-day supply from an in-network pharmacy.
Part D deductible
$350 Tiers 3-5
Tier 1
$0
Tier 2
$10
Tier 3
$47
Tier 4
31%
Tier 5
29%
Extra Benefits and Services
Clover plans include these important benefits and services. Original Medicare doesn't.
Part B Giveback (monthly)
Not included
Fitness benefit
Included
OTC allowance (quarterly)
$75
Routine dental, vision, & hearing exams
$0 in-network
Worldwide Coverage
Included
LiveHealthy Rewards
$400
Dental allowance (yearly)
$1,500
Eyewear allowance (yearly)
$300
Ready to become a Clover member?
We’re available to talk 8 am to 8 pm, 7 days a week.*