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Member Services:
Enrollment
Provider Support:
The Clever Care Value HMO plan is an MA-PD plan with Part B premium reduction.
| Member Premium | $0 |
|---|---|
| Part B premium buy-down | $130 paid by the plan |
| Deductible | $0 |
| Maximum-Out-of-Pocket | $2,900 |
| Inpatient Hospital Stay** | $120 copay per day for days 1–5 | $0 copay per day for days 6–90 |
| Outpatient Hospitalization | $0 copay per visit |
| Doctor Visits | $0 copay per visit |
| Specialist Visits | $10 copay per visit |
| Emergency Care | $110 copy per visit |
| Urgent Care | $0 copay per visit |
| Labs | X-ray | $0 copay |
| Hearing Coverage | Hearing Aids | $0 copay | $600 per ear per year |
| Dental Coverage | $200 allowance per quarter |
| Routine Vision and Eyewear Coverage | $0 copay | $200 every year |
| Transportation (Non-Emergency)* | $0 copay for 16 one-way trips |
| Flexible Health and Wellness Allowance | $100 allowance every three months |
| Acupuncture | $0 copay |
| Eastern Wellness Therapies | $0 copay up to 12 services per year |
| Worldwide Emergency Coverage | Up to $50,000 annual limit |
| Prescription Drug Coverage (Part D) | Included |
| Prescription Drug Deductible (Part D)* | $0 |
Limits and exclusions may apply. Refer to the Evidence of Coverage for a full description of benefits.
*Some benefits may vary depending on SSBCI or VBID model eligibility. Prior authorization is required. Not all members qualify.
**Medicare defined amounts are for 2024 and may change for 2025. We will provide updated rates as soon as Medicare releases them.
Your cost-sharing may differ depending on the pharmacy you choose (e.g., standard retail, out-of network, mail-order) or whether you receive a 30- or 100-day supply. If you live in a long-term care facility (LTC), you pay the same amount as you would at a standard retail pharmacy for a 31-day supply of medication. If you have Medi-Cal and share of cost, the Part D deductible will be paid in full or part by Medi-Cal or a third party. The VBID model eliminates the cost-share amount of prescription drugs for beneficiaries who receive Extra Help.
This information is not a complete description of benefits. Call (833) 388-8168 for more information.
For more information and a detailed description of benefits, please review our downloadable plan materials.
Clever Care plans include some additional benefits.
Special Supplemental Benefits for the Chronically Ill (SSBCI)
Available to qualifying members with a confirmed chronic condition and who are enrolled in Clever Care’s case management program.
Additional Supplemental Benefits
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| Member Premium | $0 |
|---|---|
| Part B premium buy-down | $130 paid by the plan |
| Deductible | $0 |
| Maximum-Out-of-Pocket | $2,900 |
| Inpatient Hospital Stay** | $120 copay per day for days 1–5 | $0 copay per day for days 6–90 |
| Outpatient Hospitalization | $0 copay per visit |
| Doctor Visits | $0 copay per visit |
| Specialist Visits | $10 copay per visit |
| Emergency Care | $110 copy per visit |
| Urgent Care | $0 copay per visit |
| Labs | X-ray | $0 copay |
| Hearing Coverage | Hearing Aids | $0 copay | $600 per ear per year |
| Dental Coverage | $200 allowance per quarter |
| Routine Vision and Eyewear Coverage | $0 copay | $200 every year |
| Transportation (Non-Emergency)* | $0 copay for 16 one-way trips |
| Flexible Health and Wellness Allowance | $100 allowance every three months |
| Acupuncture | $0 copay |
| Eastern Wellness Therapies | $0 copay up to 12 services per year |
| Worldwide Emergency Coverage | Up to $50,000 annual limit |
| Prescription Drug Coverage (Part D) | Included |
| Prescription Drug Deductible (Part D)* | $0 |
Already a member?
Call (833) 388-8168 (TTY: 711)
to speak to a Member Advocate
Interested in becoming a member?
Call (833) 721-4365 (TTY: 711)
to speak to a Medicare Advisor
8:00 AM – 8:00 PM, 7 days a week from October 1st to March 31st
8:00 AM – 8:00 PM, Monday through Friday from April 1st to September 30th
Please do not include personal identifying information such as your birth date, or personal medical information in any emails you send to us. Communications via email over the internet are not secure. Submit your rewards form via traditional postage mail, online through the member portal, or via fax at (657) 210-6635.
Clever Care Health Plan, Inc. is an HMO and HMO C-SNP with a Medicare contract. Enrollment depends on contract renewal.
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