Speak to an Enrollment Advisor:
Speak to a Member Advocate:
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.
*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.
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.
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 |
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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