2027 Medicare Advantage plan
Clover Health Valor (PPO): 2027 benefits and costs
Clover Health PPO
CMS plan ID: H5141-056-0 · Plan year: 2027
Clover Health Valor (PPO) is a 2027 Medicare Advantage plan offered by Clover Health. It is listed in Georgia, South Carolina.
2027 plan costs at a glance
Monthly plan premium$0.00
In-network medical out-of-pocket maximum$9,850.00
- Organization
- Clover Health
- Plan organization
- CLOVER INSURANCE COMPANY
- Parent company
- Clover Health Holdings, Inc.
- Plan type
- PPO
- Part C premium
- $0.00
- Prescription drug coverage
- No
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
- Monthly Part B premium after plan reduction
- $69.50 (estimated)$209.50 standard premium less $140.00 plan reduction.
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $9,850.00
- Combined in/out-of-network medical maximum
- $14,800.00
- Out-of-network medical maximum
- Not applicable
- Part B premium reduction
- $140.00
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0
| $15.00 copay
| |
| Specialist visit | $25.00 copay
| $50.00 copay
|
|
| Telehealth | $0.00 to $25.00 copay
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $115.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $25.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0
| 30% coinsurance
|
|
| Dialysis | 20% coinsurance
| 40% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 40% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 40% coinsurance
|
|
| Kidney disease education services | $0
| $0
|
|
| Medicare-covered chiropractic | $15.00 copay
| 30% coinsurance
|
|
| Medicare-covered foot care | $35.00 copay
| 30% coinsurance
|
|
| Other health professionals | $0.00 to $25.00 copay
| $15.00 to $50.00 copay
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–6: $375.00 copay per day Days 7–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–6: $320.00 copay per day Days 7–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $375.00 copay
| $0.00 to $480.00 copay
| |
| Hospital observation services | $375.00 copay
| $480.00 copay
| |
| Ambulatory surgical center | 0% to 20% coinsurance
| 0% to 30% coinsurance
|
|
| Outpatient blood | 20% coinsurance
| 30% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $250.00 copay
| 0% to 30% coinsurance
|
|
| Laboratory services | $0.00 to $20.00 copay
| $40.00 copay
|
|
| Diagnostic radiology (CT, MRI) | $50.00 to $250.00 copay
| 30% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 30% coinsurance
|
|
| X-rays | $40.00 copay
| 30% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | 20% coinsurance
| 30% coinsurance
|
|
| Intensive outpatient program | 20% coinsurance
| 30% coinsurance
|
|
| Substance use treatment, individual sessions | $35.00 copay
| 30% coinsurance
|
|
| Substance use treatment, group sessions | $25.00 copay
| 30% coinsurance
|
|
| Opioid treatment program | $35.00 copay
| 30% coinsurance
|
|
| Mental health, individual sessions | $35.00 copay
| 30% coinsurance
|
|
| Mental health, group sessions | $25.00 copay
| 30% coinsurance
|
|
| Psychiatry, individual sessions | $35.00 copay
| 30% coinsurance
|
|
| Psychiatry, group sessions | $25.00 copay
| 30% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $35.00 copay
| 30% coinsurance
|
|
| Physical and speech therapy | $35.00 copay
| 30% coinsurance
|
|
| Cardiac rehabilitation | $30.00 copay
| 30% coinsurance
|
|
| Intensive cardiac rehabilitation | $35.00 copay
| 30% coinsurance
|
|
| Pulmonary rehabilitation | $15.00 copay
| 30% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $20.00 copay
| 30% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $350.00 copay
| $350.00 copay
|
|
| Air ambulance | $350.00 copay
| $350.00 copay
|
|
| Durable medical equipment | 20% coinsurance
| 20% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 20% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 20% coinsurance
|
|
| Diabetic supplies | 20% coinsurance
| 20% coinsurance
|
|
| Diabetic shoes and inserts | 20% coinsurance
| 20% coinsurance
|
|
| Diabetic monitors | 20% coinsurance
| 20% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $25.00 copay | $50.00 copay
| |
| Oral examsAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0 | 50% coinsurance
| |
| Other diagnostic dentalAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0 | 50% coinsurance
| |
| FluorideAdditional plan benefit | $0 | 50% coinsurance
| |
| Other preventive dentalAdditional plan benefit | $0 | 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | $20.00 copay | 50% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | $20.00 copay | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | $20.00 copay | 50% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Maxillofacial prostheticsAdditional plan benefit | $20.00 copay | 50% coinsurance
| |
| Dental implantsAdditional plan benefit | $20.00 copay | 50% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | $20.00 copay | 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | $20.00 copay | 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | $20.00 copay | 50% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $25.00 copay
| 30% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0 | $0
|
|
| Medicare-covered eyewear | $0
| $0
|
|
| Contact lensesAdditional plan benefit | $0 | $0
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0 | $0
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $25.00 copay
| 30% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0 | $0
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 | $0
|
|
| Prescription hearing aids (all types)Additional plan benefit | $499.00 to $999.00 copay
| $5,000.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0
| $0
| |
| Annual physical examAdditional plan benefit | $0
| $0
|
|
| Fitness benefitAdditional plan benefit | $0
| $0
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | $0
| |
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | $0
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | $0
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | $0
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | $0
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | 40% coinsurance
|
Prescription drug coverage
This plan does not include a Part D prescription drug benefit.
Where this plan is offered
CMS lists this plan in 2 states or territories. Availability can vary by county and ZIP code.
View all locations 173 county listings across 2 states or territories
Georgia
- Appling, Georgia
- Atkinson, Georgia
- Bacon, Georgia
- Baker, Georgia
- Baldwin, Georgia
- Banks, Georgia
- Barrow, Georgia
- Bartow, Georgia
- Ben Hill, Georgia
- Berrien, Georgia
- Bibb, Georgia
- Bleckley, Georgia
- Brantley, Georgia
- Brooks, Georgia
- Bryan, Georgia
- Bulloch, Georgia
- Burke, Georgia
- Butts, Georgia
- Calhoun, Georgia
- Camden, Georgia
- Candler, Georgia
- Carroll, Georgia
- Catoosa, Georgia
- Charlton, Georgia
- Chatham, Georgia
- Chattahoochee, Georgia
- Chattooga, Georgia
- Cherokee, Georgia
- Clarke, Georgia
- Clay, Georgia
- Clayton, Georgia
- Clinch, Georgia
- Cobb, Georgia
- Coffee, Georgia
- Colquitt, Georgia
- Columbia, Georgia
- Cook, Georgia
- Coweta, Georgia
- Crawford, Georgia
- Crisp, Georgia
- Dade, Georgia
- Dawson, Georgia
- Decatur, Georgia
- DeKalb, Georgia
- Dodge, Georgia
- Dooly, Georgia
- Dougherty, Georgia
- Douglas, Georgia
- Early, Georgia
- Echols, Georgia
- Effingham, Georgia
- Elbert, Georgia
- Emanuel, Georgia
- Evans, Georgia
- Fannin, Georgia
- Fayette, Georgia
- Forsyth, Georgia
- Franklin, Georgia
- Fulton, Georgia
- Gilmer, Georgia
- Glascock, Georgia
- Glynn, Georgia
- Grady, Georgia
- Greene, Georgia
- Gwinnett, Georgia
- Habersham, Georgia
- Hall, Georgia
- Hancock, Georgia
- Haralson, Georgia
- Harris, Georgia
- Hart, Georgia
- Heard, Georgia
- Henry, Georgia
- Houston, Georgia
- Irwin, Georgia
- Jackson, Georgia
- Jasper, Georgia
- Jeff Davis, Georgia
- Jefferson, Georgia
- Jenkins, Georgia
- Johnson, Georgia
- Jones, Georgia
- Lamar, Georgia
- Laurens, Georgia
- Lee, Georgia
- Liberty, Georgia
- Lincoln, Georgia
- Long, Georgia
- Lumpkin, Georgia
- Macon, Georgia
- Madison, Georgia
- Marion, Georgia
- McDuffie, Georgia
- McIntosh, Georgia
- Meriwether, Georgia
- Miller, Georgia
- Mitchell, Georgia
- Monroe, Georgia
- Montgomery, Georgia
- Morgan, Georgia
- Murray, Georgia
- Muscogee, Georgia
- Newton, Georgia
- Oconee, Georgia
- Oglethorpe, Georgia
- Paulding, Georgia
- Peach, Georgia
- Pickens, Georgia
- Pierce, Georgia
- Pike, Georgia
- Polk, Georgia
- Pulaski, Georgia
- Putnam, Georgia
- Quitman, Georgia
- Rabun, Georgia
- Randolph, Georgia
- Richmond, Georgia
- Rockdale, Georgia
- Schley, Georgia
- Screven, Georgia
- Seminole, Georgia
- Spalding, Georgia
- Stephens, Georgia
- Stewart, Georgia
- Sumter, Georgia
- Talbot, Georgia
- Taliaferro, Georgia
- Tattnall, Georgia
- Taylor, Georgia
- Telfair, Georgia
- Terrell, Georgia
- Thomas, Georgia
- Tift, Georgia
- Treutlen, Georgia
- Troup, Georgia
- Turner, Georgia
- Twiggs, Georgia
- Union, Georgia
- Upson, Georgia
- Walton, Georgia
- Ware, Georgia
- Warren, Georgia
- Washington, Georgia
- Wayne, Georgia
- Webster, Georgia
- Wheeler, Georgia
- White, Georgia
- Wilcox, Georgia
- Wilkes, Georgia
- Wilkinson, Georgia
- Worth, Georgia
South Carolina
- Abbeville, South Carolina
- Aiken, South Carolina
- Allendale, South Carolina
- Bamberg, South Carolina
- Barnwell, South Carolina
- Beaufort, South Carolina
- Berkeley, South Carolina
- Calhoun, South Carolina
- Charleston, South Carolina
- Colleton, South Carolina
- Dorchester, South Carolina
- Edgefield, South Carolina
- Georgetown, South Carolina
- Hampton, South Carolina
- Horry, South Carolina
- Jasper, South Carolina
- Kershaw, South Carolina
- Marion, South Carolina
- McCormick, South Carolina
- Orangeburg, South Carolina
- Saluda, South Carolina
- Williamsburg, South Carolina