Clover Health 2027 Plan
Choice Giveback PPO (054)
Medical & Rx drug coverage
An all-in-one plan that includes prescription drug coverage, a Part B Giveback to reduce your Medicare Part B premium. Plus, allowance for dental, eyewear and OTC items.
Monthly Premium
$0
Primary Care Visit
$0
Maximum Out-of-Pocket
$9,850
Part B Giveback
$140
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
$50
$55
Hospital Costs
In-Network
Out-of-Network
Inpatient hospital (days 1-4)
$545
$700
Emergency care
$115
$115
Urgent care
$40
$40
Outpatient labs (Labcorp or Quest)
$0
$0
Outpatient Labs: Other Vendors
$30
$50
Prescription Costs
Prices are for a 30-day supply from an in-network pharmacy.
Part D deductible
$440 Tiers 3-5
Tier 1
$0
Tier 2
$0
Tier 3
$47
Tier 4
35%
Tier 5
28%
Extra Benefits and Services
Clover plans include these important benefits and services. Original Medicare doesn't.
Part B Giveback (monthly)
$140
Fitness benefit
Included
OTC allowance (quarterly)
$25
Routine dental, vision, & hearing exams
$0 in-network
Worldwide Coverage
Included
LiveHealthy Rewards
$400
Dental allowance (yearly)
$500
Eyewear allowance (yearly)
$200
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
$50
$55
Hospital Costs
In-Network
Out-of-Network
Inpatient hospital (days 1-4)
$545
$700
Emergency care
$115
$115
Urgent care
$40
$40
Outpatient labs (Labcorp or Quest)
$0
$0
Outpatient Labs: Other Vendors
$30
$50
Prescription Costs
Prices are for a 30-day supply from an in-network pharmacy.
Part D deductible
$440 Tiers 3-5
Tier 1
$0
Tier 2
$0
Tier 3
$47
Tier 4
35%
Tier 5
28%
Extra Benefits and Services
Clover plans include these important benefits and services. Original Medicare doesn't.
Part B Giveback (monthly)
$140
Fitness benefit
Included
OTC allowance (quarterly)
$25
Routine dental, vision, & hearing exams
$0 in-network
Worldwide Coverage
Included
LiveHealthy Rewards
$400
Dental allowance (yearly)
$500
Eyewear allowance (yearly)
$200
Ready to become a Clover member?
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